ST. PAUL, Minn., Feb. 27, 2018 /PRNewswire/ -- More than 1 million Medicaid members now make up a significant portion of Prime Therapeutics' (Prime's) total membership of more than 27 million people. As a leading pharmacy benefit manager (PBM), surpassing this milestone is a result of Prime's collaborative and consultative model that delivers clients and their members quality services while managing total cost of care.

"By closely collaborating with our health plan clients, we are able to monitor, assess, plan and respond to the changes of this dynamic, regulated market," said Rob Behler, vice president and general manager of Medicaid markets at Prime. "Our highly integrated and consultative model has not only helped us retain current Medicaid clients, but it's contributed to our growth – nearly 450 percent since 2014 – by supporting our clients' ability to gain new Medicaid business in the markets they serve."

Prime's robust Medicaid service model includes:

• Dedicated teams – Experts from cross-functional teams consult with clients on market trends and needs, and are led by a management team with more than 50 years of combined Medicaid experience.
• Flexible and aligned benefit designs – A wide variety of benefit structures and system edits are offered to support client goals and improve members' health outcomes.
• Comprehensive formulary (drug list) approach – Prime's National Medicaid Business Committee offers formulary management services to help clients with formulary development, analysis, modeling and reporting.
• Proactive clinical consultation – Pharmacists serve as clinical program managers and consult on pharmacy strategy, such as utilization management, which resulted in savings of $115 million in 2017.
• Strategic network management – Prime's comprehensive network management approach includes price negotiations, prevention of fraud, waste and abuse, and cost savings programs promoting access and affordability.
• High quality clinical programs – Prime's collaborative programming monitors for clinically appropriate use of medicines, is compliant with all state regulations, and delivers successful implementations and service excellence. This collaboration drives savings to bend the cost trend in high-cost categories such as diabetes.

"Issues like misuse and abuse of controlled substances, the prevalence of chronic and long-term illnesses, and the rising cost of medications are consistent across the Medicaid population, but they may impact our clients and their members in different ways," added Behler. "Prime's Medicaid model is delivered by experienced teams that specialize in Medicaid and follow best practice pharmacy management. Together, we work closely with our health plan clients to drive to the lowest cost, highest quality, compliant solutions that address the needs of distinct populations."

Prime's success in the Medicaid market is not limited to membership growth. Despite annual increases in the price of many medicines, Prime's PBM tools, proactive collaboration on population management and substantial negotiated savings resulted in an overall negative drug trend of -5.4 percent for Prime's Medicaid clients in 2017. Prime's complete 2017 Medicaid trend report is available in the newsroom on primetherapeutics.com.

About Prime Therapeutics
Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and offers clinical services for people with complex medical conditions. Prime serves more than 27 million people. It is collectively owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.

For more information, visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.

 

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SOURCE Prime Therapeutics

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