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Prescription Drug and Pharmacy Benefits

Integrated Pharmacy Model for Group Business

It's more important than ever to better manage pharmacy costs without compromising outcomes. Learn how our integrated pharmacy, medical and behavioral health model lowers costs for employers and employees and improves member health.

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An Approach That Delivers

Our strategy links pharmacy and medical benefits to lower overall health care costs, improve health outcomes and deliver an unrivaled member experience. Our solution uses real-time data to drive real-time results. Here's how we do it.

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Better Outcomes

Clinical programs backed by real time, integrated data support providers in optimizing care management and improving member health. The result: 7-16% lower overall risk for diabetes related vision loss and kidney disease and 15% less inpatient utilization.1

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Member Engagement

Programs leverage real time pharmacy and medical data to engage members, leading to lower costs and better outcomes. Our study showed a 42% improvement in member engagement rates with connected benefits.2

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Lower Costs

Programs target adherence, manage utilization, and leverage real-time medical and pharmacy data to drive down costs for chronic conditions. Examples: Medical cost savings for Crohn’s disease ($1,452 PMPY) and chronic kidney disease ($1,104 PMPY).2

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Aligned Incentives

Our flexible an innovative solutions across dispensing channels support the goals of your business and the needs of your employees. While others maximize profits for shareholders, we maximize value for our customers.

Effective Programs and Partnerships

Copay Assistance Program

FlexAccess unlocks access to programs across multiple dispensing channels, including retail pharmacies. Savings opportunities on targeted drugs deliver up to $6 per member per month in gross savings.2

Pharmacist Outreach Program

HighTouchRx™ integrates claims data to identify drug therapy optimization opportunities. In six months, this outreach resulted in significant savings. In 2023, pharmacist engagement of members resulted in more than $20M in hard and soft cost savings.

Affordable Versions of High-Priced Generics

Not every generic drug is low cost. But CivicaScript® brings affordable versions of high priced generic medicines to the market. For example, CivicaScript launched a prostate cancer treatment medication for less than $150.

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Member Engagement

Our digital tools increase consumer shopping and improve access. Over 90% of members self serve through digital channels3.

Aplicación móvil

Our mobile app makes it easy for members to manage medications, view their integrated benefits and explore cost savings opportunities.

Medication Finder

Members get notifications on prescription savings opportunities. Members who switch save on average of $378 annually.3

Member Rewards4

When members choose a lower cost drug, they receive a cash reward for switching.

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National Pharmacy Networks

  • Reduced Pharmacy Costs – Purchasing power and discounts keep costs low, increase savings, and improve access.
  • Expanded Access – National and regional chains, plus local independent pharmacies.
  • Choice – 30-day and 90-day supply options improve adherence and reduce costs.

Get More From Your Pharmacy Plan

Discover pharmacy benefits, tools and resources that help manage costs while meeting employers' needs.

Controlled Substance Program

A coordinated approach among providers, drug utilization reviewers and at-risk patient outreach maximizes positive health outcomes.

Specialty Review Unit

Specialty drugs treat serious or chronic conditions. As price and utilization rise, we can help with our Specialty Review Unit.

Preventive Drug Programs

These programs improve outcomes by removing barriers to access and encouraging adherence to medications.

Total Drug Management

A variety of solutions addresses the rising cost of drugs under medical benefits including infusion sites of care, channel management, and more.

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Clinical Programs

Evidence-based clinical programs include:

  • Guided Health – A proven medication outreach program addresses adherence, overuse and safety concerns
  • Utilization Management – We offer over 100 programs like prior authorization, step therapy and drug dispensing limits
  • Pharmacy Care Management – Claims data identifies harmful interactions, ensures adherence, identifies gaps in care, and uncovers cost savings.
  • Risk Identification and Outreach – A multidisciplinary collaboration mines data for at-risk member populations and implements interventions for members and providers.

 

1 Integrated Diabetes Study 2023
2 2023 Study on Condition-Specific Integration Results
3 Internal Analysis of digital-first episodes initiated via web or mobile
4 Not available for all groups