How connected are your medical and pharmacy benefits?
Consumers have more ways than ever to find and access prescription drugs, which can make gaps between medical and pharmacy benefits more costly.
Take the quiz
If an employee pays for a prescription without using your pharmacy benefit, will that purchase always appear in your plan’s pharmacy claims data?
Yes.
No.
Only for generic drugs.
Only for specialty drugs.
No.
No.
When a member pays outside the plan, the purchase may not create a pharmacy claim. That can leave part of their medication history out of the data used to coordinate care.
Next question
Could heavy ad spend for a brand-name drug raise plan costs when a lower-cost alternative may be clinically appropriate?
Only when the drug is purchased outside the plan.
No.
Yes.
Yes.
When members ask for a promoted drug by name, costs can rise. Integrated benefits can help clinical teams identify appropriate lower-cost options within the context of the employee’s overall care.
Next question
Yes.
Only when no biosimilar is available.
Which information gives employers and health plans the clearest view of how medication choices affect total health care costs?
Medical and pharmacy claims together.
Medical claims alone.
Medical and pharmacy claims together.
Medical and pharmacy claims together.
Prescription spending is one part of the equation. Connecting it with medical utilization helps employers and health plans assess how treatment choices relate to costs across an employee’s care.
Next question
Pharmacy claims alone.
Advertised prescription prices.
If an employee finds a lower advertised drug price online, does that always mean the treatment costs less overall?
Only specialty drugs.
No.
No.
No.
A prescription price does not capture the physician visits, other medications or medical services connected to the member’s treatment. Evaluating those pieces together gives clinical teams a fuller picture of both cost and care.
Next question
Yes.
Only when the insurance covers the prescription.
If an employee finds a lower advertised drug price online, does that always mean the treatment costs less overall?
Only specialty drugs.
No.
No.
No.
A prescription price does not capture the physician visits, other medications or medical services connected to the member’s treatment. Evaluating those pieces together gives clinical teams a fuller picture of both cost and care.
Next question
Yes.
Only when the insurance covers the prescription.
Can integrating medical and pharmacy benefits create opportunities to lower costs while supporting members’ care?
Only by limiting medication choices.
No.
Yes.
Yes.
An integrated approach can help clinical teams identify appropriate lower-cost therapies, contact members proactively and coordinate medication decisions with their broader care.
Next steps
Yes.
Only after a high-cost claims occurs.
Next steps
Members receive more coordinated guidance and employers are better equipped to manage rising drug costs when medical and pharmacy benefits work together at Blue Cross Blue Shield of Massachusetts.
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