Pharmacy Benefit Management: A Strategic Approach to Self-Insured Cost Control

Pharmacists

July 24, 2025 | Tags: Employee Benefits

Managing healthcare costs for a large workforce can feel complex, but it doesn't have to be. By integrating pharmacy benefits with your medical plan through a “carve-in” approach, self-insured groups can simplify administration, enhance care coordination and gain full visibility across vendors while maintaining control over costs.

Medical Mutual’s pharmacy benefit management (PBM) services provide a comprehensive approach geared toward maximizing savings and improving health outcomes. Here’s why you should carve-in: 

  1. Data-driven predictive support and care 

    Medical Mutual’s PBM utilizes data to provide insights into ways we can identify and engage with high-risk members to ensure appropriate use of certain medications, such as opioids. With a focus on early education and prevention, our program guides members toward high-quality, local treatment providers. Employees with chronic conditions can experience faster enrollment into management programs and specialty therapies, leading to more personalized and effective care.  

  2. Greater cost transparency and control  

    Medical Mutual’s pharmacy team reviews new drugs and pricing changes weekly, enabling us to take quick, proactive steps to manage costs while ensuring continued access to clinically effective, lower-cost options.  

  3. Accountable PBM oversight 

    Improved transparency and cost control stem from proactive PBM monitoring strategies. Through pharmacy evaluations, we identify and address excessive compound and high-cost claims while ensuring PBM invoices are fully aligned with contract terms. Regular business audits further strengthen oversight to protect your business from unnecessary spending. 

  4. Local expertise and dedication 

    Medical Mutual ensures patients receive the most appropriate and cost-effective treatments through visibility across specialists in the Ohio healthcare landscape, including pharmacists, nurses, nutritionists and social workers. Our dedicated team of over 60 pharmacy experts track local and out-of-state prescribing patterns to prevent costly dispensing errors and save money for members and groups. 

  5. Medical Mutual + PBM integration contributes to lower costs 

    Through extensive internal and external studies with Express Scrips, Medical Mutual showcases how integration lowers costs and improves member outcomes. “Medical and pharmacy benefits should be seamlessly integrated,” said Dr. Marko Blagojevic, Vice President, Pharmacy Management. “By uniting these benefits, employers can realize significant savings on healthcare costs and enhance the overall well-being of their workforce." 

PBM integration isn’t just a strategy; it’s a proven solution. Here’s what Medical Mutual found:  

  • Carve-in groups experienced between $13 to $23 potential savings per employee per month (PEPM)* when compared to carve-out groups.  
  • Medical Mutual’s Administrative Services Only (ASO) Custom PBM Program drove over $43 million in utilization management savings.** 
  • Utilization of GLP-1s, a top indication, was 19% lower with Medical Mutual than the coalition peer.**

Take your next steps to better care 

Click to view our large group page or contact your broker or a Medical Mutual Sales representative to explore how your business can unlock the full potential of our Pharmacy Benefit Management services. 
* Data based on Medical Mutual’s internal comparison study conducted from Jan-Jun 2024 period. 
** Data based on Express Scripts study from Jan-Jun 2024 period. 

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