INTEGRATED PRODUCT SOLUTIONS SYSTEMS

Prime’s sophisticated system seamlessly provides integrated medical and pharmacy products to members. The integrated product solutions (IPS) system enables the management of even more sophisticated products and offers real-time transactions for synchronized benefit accumulators and flexible benefit designs, as well as access to accounts for consumer-directed health plan (CDHP) products.

MEDICARE PART D

Prime administers Medicare Part D plans for several clients and offers:

• Member services assistance to Medicare Part D beneficiaries with enrollment, eligibility and pharmacy-related questions
• Education and information for network pharmacists on procedures to fill Part D prescriptions
• A dedicated help desk specifically for pharmacists with Medicare questions
• A web site, http://www.MyRxAssistant.com/ :specifically for Medicare Part D members that includes a pharmacy locator, a formulary search and additional forms and information
• Assistance for clients in administering Part D formularies, pharmacy networks and clinical programs
• A Medication Therapy Management Program (MTMP)

PRIMEIMPACT^SM CLINICAL STRATEGIES

PrimeImpact is a clinical program that provides optimal patient care and cost containment. It targets 14 core clinical categories –  representing 60 percent of our clients’ annual prescription drug expenditures.

Through combining medical and pharmacy claim data, PrimeImpact delivers more accurate targeting, higher provider and member satisfaction, increased ROI and better quality of care outcomes. The results are measurable and the program is delivered through a variety of options:

• Member and provider education
• Dose optimization
• Prior authorization
• Retrospective DUR (Drug Utilization Review)
• Quantity limits
• Step therapy
• Formulary design

PRIMERXSPECIALTY

PrimeRxSpecialty utilizes experts in various areas to provide patient care, drug information and disease information to patients with unique medical conditions. Our account team works closely with you to develop the programs that best meet the needs of your organization, your members and your providers. This ensures that the right drug is delivered to the right patient at the right time. PrimeRXSpecialty offers:

• Benefit design solutions
• Market-leading discounts for specialty claims pharmacy benefits
• Medical and pharmacy integration
• Safety letters utilizing medical diagnosis and pharmacy claims history
• Integrated claims processing to reduce duplicate billing
• Waste management

PHARMACY NETWORKS DEVELOPMENT AND ADMINISTRATION

At Prime, our network management approach is based on the premise that the retail pharmacist is vital to a successful pharmacy management program. We work with you to meet your specific network goals, whether you select one of our national networks or engage us to develop, or customize, a network on your behalf. We provide all participating pharmacies with exceptional service and state-of-the-art tools to administer your program.