Debunking Pharmacy Carve-Out Myths & Common Medical Carrier Pushback

For employers looking to lower their employee benefit costs or overall pharmacy costs, one way to do that is to look at carving them away from their current arrangement, which is most likely through their medical carrier or their medical TPA. There are several reasons for that and many benefits of a carve-out arrangement, but a lot of time employers looking to carve-out pharmacy will get pushback from the medical carrier or the medical TPA.

Carrier Argument:

The most common pushback is that they’re handling the pharmacy and the medical to do basically an integration of the benefits.

Debunking the Myth:

When you get the pushback about integrating the pharmacy data and the medical data and them doing some kind of behind-the-scenes analysis that helps control spend and member experience, it’s really a red herring. The data on the pharmacy side is coming from an outside source, even in your carved-in arrangement. So when you carve-out, if any of that claims data is being given to the medical carrier, that connection can still be maintained.

Carrier Argument:

Employers also get some pushback about really just having one common place to go, to have one place to solve all of their different issues.

Debunking the Myth:

When it gets down to it, are the medical vendor or carrier or TPA systems and associates the ones who should be answering questions on pharmacy? Or would you rather be getting that from pharmacy experts?

Learn more about the value of carving-out pharmacy benefits in our free on-demand webinar, Blazing a Trail to Carving-Out Pharmacy.

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