What distinguishes "prior generation" prescription drug plans (PDP) from today's "carved-out" plans?

The distinguishing factor between "prior generation" prescription drug plans (PDP) and today's "carved-out" plans primarily revolves around administrative management changes. Prior generation PDPs were often integrated within a broader medical benefits framework offered by health plans, leading to a less specialized approach to managing prescription drugs. In contrast, carved-out plans represent a shift in which the prescription drug benefits are managed separately from other health benefits. This allows for more targeted management strategies, including negotiating prices directly with pharmaceutical companies, utilizing pharmacy benefit managers (PBMs), and implementing more sophisticated utilization management techniques to control costs and improve outcomes.

The focus on administrative management in today’s carved-out plans often leads to enhanced efficiency, better data analytics, and improved services specifically related to pharmacy benefits. As healthcare evolves, the specialization offered by these plans has become increasingly important to address the complexities of pharmaceutical care, thereby providing a clearer distinction from older models.