Whole Health and Pharmacy: The Overlooked Alliance in Chronic Disease Management

Picture a room of ten people. In the United States, six of these ten are living with at least one chronic condition like cancer, diabetes, or heart disease. Four of them are managing two or more.

Now imagine their healthcare journeys. Individuals with complex, chronic conditions often face a fragmented system. They juggle visits to primary care providers, specialists, behavioral health professionals, and multiple pharmacies. But even with this high level of engagement with numerous providers, there are gaps in care. To truly improve outcomes and patient experiences, we must move toward integrated, whole health care.

Whole health recognizes that a person’s well-being depends on more than clinical interventions alone. Behavioral, social, and physical health all matter and must work in unison. One crucial player remains underleveraged in this whole health equation: pharmacy services. Coordination of pharmacy services (including pharmacists, PBMs, specialty, infusion, and home delivery) is essential to managing chronic conditions for patients.

In the U.S., more than 4 billion prescriptions are filled each year. Older adults who are living with multiple chronic conditions fill an average of 50 prescriptions a year. These adults can see more than 10 different physicians each year and make more than 30 visits to physician offices. That makes pharmacists and pharmacy benefit managers critical, yet often underutilized, players in the healthcare ecosystem. When equipped with real-time data and integrated into the care team, they can proactively identify health risks, support care coordination, and close medication adherence gaps. This helps make healthcare more affordable and, more importantly, helps improve health outcomes.

At Carelon and CarelonRx, we've seen these results firsthand. Our Specialty Conditions Value of Integration Study found that when medical and pharmacy benefits are integrated, members experience more than $100 in monthly all-cause medical savings and over $66 in inpatient savings per member per month. In addition, for members with integrated benefits taking specialty medications, inpatient utilization dropped by 6.3%, and hospital stays were 13.1% shorter.

These outcomes show what’s possible when pharmacy services are connected to the broader care delivery model. Shared clinical data and connected care providers who help guide patients through treatment plans lead to improved healthcare experiences and consistent care.

This is especially true for patients using specialty medications for conditions like multiple sclerosis, Crohn’s disease and cancer. These drugs are often expensive, require frequent monitoring, and can be difficult for patients to manage alone. Without support, adherence drops and outcomes decline. By integrating pharmacists into the care team, they become clinical partners to patients and can help patients manage side effects, select cost-efficient sites of care, stay on therapy, and coordinate across care providers.

Achieving this whole health vision requires collaboration. Providers, payers and pharmacists all have a role to play. We need to break down data silos to increase line of sight across patients’ health plans, align incentives around better health outcomes, empower pharmacists as a critical part of the care team, and treat people as whole individuals, not a collection of diagnoses.

When care is built around the whole person, outcomes improve. People are more likely to take their medications, avoid preventable hospital visits, and feel supported throughout their health journeys. As a result, the healthcare system becomes more effective and efficient.

Now is the time to scale integrated models that deliver this level of care.

We encourage healthcare leaders to partner across sectors, invest in whole health strategies, and recognize pharmacy services as an integral part of improving.

Peter D. Haytaian serves as executive vice president, Elevance Health, and president, Carelon. Amy Mulderry is president of CarelonRx.