The benefits of pharmacy integration
If you offer health insurance benefits to your employees, the rising cost of pharmacy drugs might be one of your top concerns. Of the total benefits cost — the combined cost of medical and pharmacy benefits — pharmacy now accounts for about 25%1.
Across the United States, prescription drug costs are higher than ever and still on the rise. In fact, drug spending is projected to reach $1 trillion in 2026, up from $915 billion in 2025.
What's more, the cost of name brand prescription drugs is outpacing other health care services and causing patients to miss out on needed drug therapies due to excessive out-of-pocket costs and increasing premiums.
With pharmacy costs continuing to rise, you might be thinking about how you can control costs and provide the best options for your employees.
Learn from Wellmark’s pharmacy expert
We know employers are looking for a pharmacy management strategy that lowers costs, improves clinical outcomes and provides a better member experience. In this free webinar, Wellmark pharmacy expert, Shanda Harclerode, explains the key components of an integrated pharmacy benefit that meet those objectives.
Carve-in vs. carve-out pharmacy
When designing your pharmacy program, there are two models to consider: carving-out or carving-in pharmacy with medical benefits.
Carve-out pharmacy model — Employers contract with a separate company for pharmacy benefits, apart from medical benefits.
Carve-in pharmacy model — Employers use one health plan for both medical and pharmacy benefits. In this arrangement, the medical benefits administrator will work with a pharmacy benefits manager (PBM) to process pharmacy claims and administer the pharmacy program.
The Wellmark Blue Cross and Blue Shield Pharmacy Program handles compliance, strategy and the relationship with a top-tier PBM so you can focus on what matters most — your employees’ health.
Benefits of integrated pharmacy
We take a combined approach to help you meet your health care goals that leads to:
Improved specialty drug affordability
With many drugs coming out soon under the medical benefit, it’s important to have the flexibility to attain coverage for specialty drugs through either the medical or pharmacy benefit, giving you the ability to evaluate differing rates between channels.
Additionally, because of the large number of specialty drugs anticipated under the medical benefit, it’s important to have a partner that can leverage its relationship with the provider network to secure deeper discounts for you.
Simplified plan administration
Managing multiple vendors can be time-consuming and complex. Integrated pharmacy benefits ease the administrative burden by coordinating policies, providing comprehensive reporting and consolidating billing and employee eligibility.
Lower cost of care
Research shows that businesses benefit from integrated medical and pharmacy benefits. According to a study published in the Journal of Managed Care & Specialty Pharmacy, members with integrated pharmacy benefits had lower total medical spending compared with members whose pharmacy benefits were not integrated.
Improved health outcomes
When pharmacy is integrated with medical benefits, coordinated claims data can identify and close gaps in care, so your employees receive the best care possible.
In a Cambia Health solutions study, the coordinated care approach resulted in lower medical costs, fewer hospitalizations and fewer emergency visits over a one-year period.
Additionally, among chronic conditions, the study found significantly lower hospitalization and emergency events for participants dealing with asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and depression.
A seamless member experience
There's a lot of fragmentation in the health care system today. Often, members don't know where to call with questions or inquiries and may feel unsure navigating health care in general. An integrated medical and pharmacy plan solves for many of these issues by providing your employees with greater consistency and security through:
- Access to medical and pharmacy benefits with one member ID card.
- A single point of contact for viewing benefits and speaking with customer service.
We discussed the impact on members with Shanda Harclerode, team leader for Wellmark clinical pharmacy operations, and she shared a story about a member who could have benefited from pharmacy integration.
"We had a case where a member who did not have integrated benefits was hospitalized. The health care provider wanted the member to initiate a new therapy upon discharge, but the member ended up staying hospitalized for several additional days as the provider struggled with confusion around the drug coverage and authorization through the outside pharmacy benefits manager. The result was a significant and unnecessary hospitalization cost for the group," Harclerode said.
In this instance, the member could have had a better experience with combined pharmacy and medical benefits.
We are focused on helping you achieve results
Save money, time and effort by combining your Wellmark medical benefits with our innovative pharmacy program. Email us at blueatwork@Wellmark.com so we can connect you with an Wellmark Authorized Representative to discuss pharmacy integration for your business.
Article resources
1Wellmark Blue Cross and Blue Shield. (2025). Wellmark large group data.
Disclaimer
This article is intended for Wellmark's self-funded large groups.