EXECUTIVE SUMMARY
BLUE CROSS BLUE SHIELD OF NORTH DAKAOTA AND PRIME THERAPEUTICS…
PROVIDING EFFECTIVE MANAGEMENT OF YOUR PHARMACY BENEFIT
Blue Cross Blue Shield of North Dakota (BCBSND) and Prime Therapeutics have been partners in pharmacy management for more than five years. A solid relationship, one built on the strength of trust and ownership, BCBSND appreciates the opportunity to provide our unique and effective pharmacy management approach to your organization. We understand that you are interested in finding the lowest cost prescription benefit plan, but also offering your employees competitive benefits that are valued and appreciated. Our pharmacy management approach ensures you find the right balance to meet both of these objectives.
HISTORY OF PRIME THERAPEUTICS
Prime Therapeutics, Inc. is a pharmacy benefit solutions company dedicated to providing innovative, clinically based and cost-effective pharmacy solutions for its clients and their customers. The company was created in 1998 through the combination of Pharmacy Gold, Inc., which specialized in clinical programs, formulary management and manufacturer contracting; and Propar Services, Inc., which specialized in claims adjudication technology. Prime Therapeutics is now jointly owned by several Blue Cross Blue Shield plans, including BCBSND.
CHOOSING THE RIGHT PHARMACY MANAGEMENT STRATEGY — LOOK FOR INTEGRATION
Part of your assessment in choosing a Pharmacy Benefit Manager (PBM) is determining what makes sense for your organization — to bundle pharmacy management with medical management — or to "carve out" pharmacy, which is typically the approach offered by other PBMs. BCBSND and Prime Therapeutics believe in the value of an integrated program. Integration of pharmacy and medical management strategies is so powerful because it allows you to look at the entire health care picture. Actions taken to manage the pharmacy benefit will directly impact medical cost. The "carve-out" of the pharmacy benefit from the health plan, where networks, systems, formulary design, etc. are outsourced, places your pharmacy program in the hands of vendors whose interests are not necessarily aligned with those of your health plan. This is why our medical directors work closely with Prime Therapeutics’ clinical staff to ensure consistent strategies are being applied to your programs. Also, with access to both pharmacy and medical data, we can better identify providers and/or members for education based on diagnosis and other criteria.
COMPREHENSIVE AND INNOVATIVE PROGRAMS
Working with Prime Therapeutics, BCBSND is able to provide comprehensive services to meet your pharmacy management needs. From the basic to the unique, we will implement the programs to meet your financial and clinical objectives. Services include:
- Benefit design consultation
- Claims processing
- Formulary management
- Information reporting
- Mail service
- Manufacturer contracting
- Member- and provider-directed clinical programs
- Pharmacy network management
A COMMITMENT TO CONSULTATIVE SERVICE
BCBSND works closely with you to manage your pharmacy benefit. You can count on our pharmacy professionals to provide benefit and program recommendations based on your needs and changes in the pharmacy industry. We provide regular performance reports so you are always aware of the progress of your program, and we provide recommendations on ways to ensure you continually maximize the value of your program.
BCBSND has a dedicated team of pharmacy professionals at Prime Therapeutics, working with us daily to ensure our clients’ pharmacy objectives are being achieved. Together, we identify your business objectives and then work with you to meet them.
NO CONVERSION HASSLES
As you evaluate other pharmacy benefit management vendors, we would like you to consider total conversion costs. During your evaluation, please keep in mind the following areas that may be affected by choosing a carve-out program.
- Customer service — separation of coordinated support between the health plan and pharmacy benefits
- Claim and eligibility file setups — places significant work and cost burden on I.S. resources
- Integration — loss of inter-related data analysis to track and medically manage group health comprehensively
- Conflict of interest — addition of possible competing financial relationships that steer the drug choice, formulary structure, and/or dispensing locations
INDEPENDENCE TO SERVE YOUR BEST INTERESTS
BCBSND is proud to work with Prime Therapeutics because it has removed itself from conflicts of interest. The value of this independence should not be underestimated. Prime Therapeutics is free to promote the most appropriate, cost-effective therapies, regardless of ownership. It does not have hidden incentives from drug manufacturers, mail service suppliers, retail chains, or wholesalers driving its decisions. Our goal at BCBSND is to do what is right for you and your employees. The independence of our pharmacy management partner means we are free to focus on lowering your overall health care costs.
PROVIDING VALUE
BCBSND understands that organizations today face several challenges as they analyze health care dollar spend. Continuing cost increases, balanced with employee satisfaction and retention concerns, mean that many options must be weighed. We believe that a prudent strategy — one backed by industry experts — is to partner with one’s current health care vendors to provide a long-term strategy aimed at improved care management.
Pharmacy is the most utilized benefit you offer; it literally touches all employees from a service standpoint and leverages, positively or negatively, your total medical costs. BCBSND’s pharmacy strategy can meet your clinical and financial objectives, without upsetting your employee population or sacrificing quality of care.
We hope to work more closely with your organization in helping you manage your pharmacy benefit. We look forward to building a strong business relationship and developing a shared, timely vision for managing health care costs together.