The "pharm-to-table" blind spot employers may be missing

The consumer experience has changed faster than many employer benefits strategies, giving employees more ways to find prescription drug options outside the traditional plan experience.

• Direct pharmaceutical channels now extend across a growing range of conditions, including chronic and specialty care like migraines, fertility and arthritis.

Why it's important: Pharmaceutical companies are spending more to reach people where they already spend time — through social feeds, digital prescribing services and direct purchasing channels.

Key numbers:

• Overall ad spend has tripled in a decade, from $12.2 billion in 2015 to an estimated $39 billion in 2025.
• Digital ad spend is pulling ahead, estimated at $24.8 billion in 2025 versus roughly $7.9 billion for traditional ads like TV.

This marketing can position streamlined digital pharmaceutical channels, or "pharm-to-table" platforms, as a simpler path to treatment.

Okay, but: Employers lose opportunities to manage the total cost of care when medical and pharmacy benefits operate separately.

As the path from promotion to prescription increasingly becomes more direct, employers need health plan partners that can keep clinical guidance and cost management connected.

The challenge: A prescription obtained outside the pharmacy benefit creates a clinical blind spot when the health plan cannot connect that medication to the rest of the member's care.

A clinical team might have a record of the member's diagnosis and medical treatment but not see a medication that could affect both.

• The team may have less information to evaluate medication safety or coordinate treatment.
• The member could miss an opportunity to consider a clinically appropriate, lower-cost alternative.

Connected data helps clinical teams reach members earlier, when they still have an opportunity to consider an appropriate lower-cost option.

The solution: Blue Cross Blue Shield of Massachusetts (Blue Cross) connects medical and pharmacy benefits so its clinical teams can see more of a member's health information in one place.

That integrated view can also help employees understand the value of using their benefits before going direct to consumer, while giving employers a fuller view of care so more effective, lower-cost options can be recommended.

The impact: Examining pharmacy and medical information together helps a health plan evaluate those connections rather than treating each prescription as an isolated expense.

• Members get one more connected source of guidance instead of navigating separate medical and pharmacy systems on their own

Integrated data can also give clinical teams an opportunity to act earlier.

• Instead of waiting until a costly treatment pattern appears in claims, they can identify relevant medication use and discuss appropriate alternatives with members when those options exist.

An example: Blue Cross points to one member example showing how connected claims data can help uncover the cost of medication nonadherence.

Because Blue Cross could see both medical and pharmacy claims, its clinical team identified a pattern: The member was not filling several prescriptions and was making frequent ER visits.

• The team learned that more than $350 in monthly copays was making the medications difficult to afford, while the member's provider was unaware the prescriptions were going unfilled.
• Blue Cross identified an alternative that combined the medications and brought the member's cost to $0 a month, with no additional steps required from the member.

The impact: The member's monthly medication cost fell from more than $350 to $0, and the member experienced fewer costly ER visits.

The takeaway: Consumers have more ways than ever to encounter and access prescription drugs. Employers need a health plan partner that can keep medical and pharmacy care connected as those options multiply.

• Integrated benefits can give members more coordinated guidance while helping employers identify opportunities to control pharmacy costs across the full care journey.

For employers, the opportunity is to choose a health plan partner with the data and clinical capabilities to make those connections for members.

Next steps: Talk with your broker or Blue Cross sales representative to learn more about integrated pharmacy benefits.