Why Carved-Out Pharmacy is the Key to Your Success

Top 3 Things You’ll Learn

  1. How carved-out pharmacy benefits fits into today’s healthcare market
  2. Value of a carved-out arrangement for non-Fortune 100 companies
  3. How to find out if carved-out pharmacy is best for your clients

Corporate mergers, acquisitions, and new subsidiaries dominated the pharmacy benefit industry last year. CVS Health buying Aetna, Cigna buying Express Scripts, and Anthem starting its own pharmacy benefit manager (PBM) – to name a few. With the emergence of these new healthcare entities, many are wondering how carved-out pharmacy arrangements fit in to the conversation.

For non-Fortune 100 companies, carving-out pharmacy is still a critical component of managing health care benefits. Without having the scale of the large enterprises, non-Fortune 100 companies continue to face a financial, service and clinical disadvantage in many carved-in pharmacy arrangements. Under a carved-in plan, your clients sacrifice group purchasing power and contract negotiation opportunities that have the potential to yield substantial savings. In contrast, a carved-out pharmacy arrangement can provide the dedicated pharmacy expertise and tailored solutions that are necessary components for ensuring that their pharmacy benefit receives the same due diligence as the medical benefit.

It’s important to note that all the major PBMs are still selling carve-out plans every day. For example, UnitedHealth Group still has its Optum division, which is dedicated to pharmacy benefits. These large companies understand the need for dedicated pharmacy expertise and solutions tailored to individual companies, especially at the mid-market level. Carving-out provides both.

For non-Fortune 100 companies, carving-out pharmacy is a critical component of sustainable healthcare benefit plans. #carveout #pbm

Carving-out really is about three things: transparency, control, and insights.


Carving out gives employers access to data that allows them to see what’s happening with their benefits. When a company is carved-in, they can’t see the details behind their contract, and have no guaranteed rights when it comes to pharmacy contract terms. Carving out allows the employer to see the data for their organization, understand what they’re getting for their money, and request guarantees that support their budget and goals.


Having control means having the power to choose what’s right for you. Giving employers the power to choose what’s best for their company, their employees, and their members when it comes to pharmacy benefits, trend management programs, and contract terms is an important benefit of carving out. Employers can implement programs tailored to their members that help them manage their trend while minimizing disruption. The employer can decide, with guidance from a clinical expert, which programs are right for them.


An employer may receive data on their trend and performance from an insurer, but unless they have someone on staff with the expertise to be able to interpret the data, it may not help them in making decision. Companies that carve-out have access to dedicated pharmacy teams that know how to examine their data and provide the guidance they need to make informed decisions.

Despite what some carriers may say, carving-out still provides critical insights and value for companies that want to effectively manage their pharmacy spend. Rather than sit back and wait for your client’s pharmacy plan to improve, you can act now to ensure their pharmacy benefit arrangement is serving them well. The best way to understand the options is to undergo a market check, compare the alternatives, and make a change if warranted. Making changes on your terms, instead of being forced into unwanted changes, is the only way you can ensure your clients are protected and equipped with a sustainable pharmacy arrangement.

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