Which of the following is a disadvantage of integrating medical and pharmacy benefits?

Integrating medical and pharmacy benefits can lead to various advantages, but one significant disadvantage is the potential for higher usual and customary charges. When medical and pharmacy benefits are combined, it can sometimes result in a scenario where provider payment systems are complex, leading to unintended cost increases for patients. In some cases, the integration may not achieve the expected administrative efficiencies, making it challenging to manage costs effectively.

This situation can arise because the blending of benefits might result in conflicting pricing structures or challenges in negotiations with providers. As a result, patients may be subject to higher out-of-pocket costs for their medications, especially if there are discrepancies in how benefits are processed or if providers’ customary charges exceed those anticipated under a more traditional pricing model.

The other options represent benefits of integration rather than disadvantages. Increased control over costs enables better management and pricing strategies. Enhanced formulary management allows for improved medication selections and cost-effectiveness, while improved patient outcomes are often seen as a key goal of integrated care, as better coordination can lead to more comprehensive treatment plans.