Integrating pharmacy and medical benefits for specialty drug management | AMCP Annual 2026

Patients receiving specialty drugs often find their medications split across two separate benefit structures with some drugs covered under the pharmacy benefit and others under the medical benefit.

Sponsors need a unified view connecting the two to be able to understand the disease burden and the overall health status of the member, Yuqian Liu, senior director of specialty clinical solutions, at Prime Therapeutics, said in an interview ahead of the AMCP Annual Meeting being held in Nashville from April 13, 2026, to April 16, 2026.

The challenge for managed care organizations lies in bringing two completely different sets of processes together. Her team’s approach is designed to make access easier and outcomes better for patients.

Integrated members cost health plans and employers roughly $900 less per member per year. The savings flow primarily from reductions in hospitalizations and ER visits. These are medical cost offsets made possible by smarter, more coordinated drug management. Additionally, savings can be seen with elimination of duplicate therapies, overutilization, and harmful drug interactions.