Coordinated Medical and Drug Benefits Linked to Employers Saving Health Care Expenses

INDIANAPOLIS--(BUSINESS WIRE)-- Medical and pharmacy benefits managed by WellPoint’s affiliated health plans are linked to lower medical costs of $8 to $16 per employee monthly compared to those without an integrated pharmacy program, according to an independently verified analysis of members in WellPoint’s health plans.

The analysis shows that the integration and coordination of medical and pharmacy benefits, as well as other factors, are generally associated with lower medical costs compared to employers who do not have WellPoint affiliated health plans’ integrated pharmacy programs.

“When both medical and pharmacy benefits are managed by WellPoint’s affiliated health plans, there’s a consistent approach to a member’s care,” said Ken Goulet, WellPoint executive vice president for commercial business. “Coordinated pharmacy and medical benefits help improve the health of members, which can lead to lower medical costs from things like fewer inpatient days, ER visits and doctor visits.”

WellPoint health plans’ coordinated benefits include:

  • A drug list developed to help improve the health of members and reduce total costs
  • Gaps-in-care messaging from timely and accurate pharmacy, medical and lab data that engages both members and their doctors to better coordinate care
  • Coordination of medical and pharmacy programs to help ensure programs are based on same goals and have resulted in increased compliance with evidence-based guidelines
  • Alignment of medical and pharmacy policies that help save in overall healthcare costs rather than shift costs from one benefit to the other

“For example, WellPoint’s affiliated health plans send customized care notes to members about preventive screenings and drug options,” said Goulet. “Unlike employers that offer our health plans’ medical benefits and carve out their pharmacy benefits, we can identify members’ doctors and send the same message to them to make sure they are aware of potential gaps in care and to assist them in their patients’ care.”

The WellPoint analysis was independently verified by Michael B. Nichol, Ph.D., professor of health policy at University of Southern California.

“This analysis demonstrates the importance in conducting these types of assessments,” said Nichol. “WellPoint has made a significant effort to control for the most common issues that arise in real-world studies.”

Medical and pharmacy policies used by WellPoint’s health plans are aligned, which is especially important with the increased use of more expensive specialty drugs that are sometimes accessed through both the medical and pharmacy benefits.

For example, in some health plans, a specialty drug may be used off-label for a different condition, even though there is no evidence to prove that it is clinically effective for that condition. Alignment of medical and pharmacy benefits helps encourage appropriate use of medications that may be paid for through either channel, resulting in appropriate care, improved health for our members and reduced costs.

In creating the drug list to help improve member health, WellPoint looks across its plans’ medical and pharmacy claims to determine which drugs are likely to work best for members.

“When drug and medical benefit policies are coordinated, we can better ensure members are getting coverage for medications with solid research supporting their appropriate use,” said Jeff White, WellPoint director of drug evaluation and clinical analytics. “This is something that is more difficult to influence for those with pharmacy benefits provided by a separate company.”

By reviewing medical and pharmacy records for those members taking drugs to treat osteoporosis, an analysis indicated that members had fewer fractures, better compliance and also lower total costs with two of the three most commonly used drugs to treat osteoporosis.

“Because members had better outcomes with these two drugs, the overall healthcare costs to treat these members were lower,” White said. “These are the type of things that companies offering pharmacy benefits alone won’t know. We made sure that these drugs were available at less expensive copays than the other drug to encourage members to take the drugs that likely resulted in better health.”

The integrated care analysis included 524,360 members in WellPoint’s affiliated health plans who had both medical and pharmacy benefits and members who had medical benefits only. The study included both self-insured and fully-insured commercial members in national accounts and local groups representing 14 states from July 1, 2009, to June 30, 2010. The lower allowed medical cost savings that were associated with integration and coordination of medical and pharmacy programs were confirmed in the general population, as well as common drug-dependent disease states that drive overall costs, including diabetes, coronary artery disease, congestive heart failure, hypertension, stroke and chronic kidney disease.

About WellPoint, Inc.

WellPoint works to simplify the connection between Health, Care and Value. We help to improve the health of our members and our communities, and provide greater value to our customers and shareholders. WellPoint is one of the nation’s largest health benefits companies, with 34 million members in its affiliated health plans, and a total of more than 65 million individuals served through its subsidiaries. As an independent licensee of the Blue Cross and Blue Shield Association, WellPoint serves members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. In a majority of these service areas, WellPoint’s plans do business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia, Empire Blue Cross Blue Shield, or Empire Blue Cross (in the New York service areas). WellPoint also serves customers throughout the country as UniCare and in certain California, Arizona and Nevada markets through our recently acquired CareMore Health Group, Inc. subsidiary. Additional information about WellPoint is available at


WellPoint Media Contact:
Lori McLaughlin, 317.488.6898
[email protected]

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