Integrated benefits deliver what employers need most: healthier members, lower costs, and better data to drive decisions. The proof is in the numbers.
New research from Capital Blue Cross shows that employers that integrate medical and pharmacy benefits with Capital gain clearer insights—and save more money—than those that separate them.
In fact, self-funded employers that integrated their medical and pharmacy benefits saved an average of $200 per member in 2024 compared to those that “carved out” pharmacy with someone else.
Those savings were even higher for certain chronic conditions:
Coronary Artery Disease – $1,049 per member per year
Depression – $649 per member per year
Chronic Obstructive Pulmonary Disease (COPD) – $601 per member per year
Asthma – $525 per member per year
“You can’t manage what you can’t see,” said Gary Petruzzelli, VP Pharmacy Strategy & Services at Capital Blue Cross. “Some employers pursue short-term savings by carving out pharmacy benefits with separate vendors. But that often sacrifices real-time data and limits the view of employee health."
How Integrated Benefits Lead to Smarter Decisions
#1: Reducing Risks
When pharmacy and medical data aren’t connected, critical issues can go unnoticed, especially for members managing chronic conditions like diabetes.
In one case, a member with diabetes had started treatment with Mounjaro and Ozempic, two costly GLP-1 therapies that wouldn’t be prescribed together. The overlap was identified because integrated data flagged the duplication. A pharmacist promptly contacted the member’s provider, who streamlined treatment to a single therapy.
Outcome: The member received appropriate care and the employer saved $11,500 over the course of a year.
“Catching these kinds of issues in real time can make a huge difference, not just financially, but also for member safety,” Petruzzelli said.
#2: Closing Gaps in Care
Integrated benefits make it easier to find and close gaps in care, especially for your employees managing chronic health issues.
Capital Blue Cross uses a proprietary predictive model to flag members whose prescription needs can fall through the cracks due to missed refills, multiple prescribers, or lack of follow-up care. Capital’s care management team then steps in to help.
One example: A pregnant mother with a thyroid condition had trouble getting her $25/month medication. Capital’s care management team found the same medication for $1/month through an online discount and arranged for pickup at a nearby pharmacy.
Result: The member managed her condition, saved money, and gave birth to a healthy baby.
#3: Managing Site of Service
Site of service is one of the biggest drivers of pharmacy costs, especially for infused medications—ones given through an IV or injection.
With integrated data, Capital helps employers analyze where these high-cost therapies are being administered and can help find lower-cost alternatives, without compromising quality.
Example: Infusion drugs used to treat arthritis, heart disease, or cancer can cost an average of $5,500 to $11,500 in a hospital versus $1,700 to $3,500 at home.
“Once we know how and where medication is delivered, we can help employers and providers shift to more cost-effective site-of-service options,” Petruzzelli said. “That’s the kind of insight you only get when medical and pharmacy data are working together.”
Connect with Capital
This isn’t just about saving money—it’s about delivering safer, more coordinated care.
“Every employer is different, with unique populations and needs,” said Dr. Jeremy Wigginton, Chief Medical Officer at Capital Blue Cross. “There isn’t a one-size-fits-all approach that works. That is why full data integration is so important.”
Connect with Capital Blue Cross to explore how integrated medical and pharmacy data can help your organization reduce waste, improve outcomes, and take control of healthcare costs.