Improving Formulary Transparency 

We remain committed to delivering the best drug management experience while empowering members to make the best decisions for their health and hard-earned dollars​. 

One way we do this is through Prime’s Therapeutic Alternatives Capability (TAC). It removes the mystery of what medicines are covered for a given condition, helps members find economical options and reduces unnecessary prior authorizations. TAC helps support Prime’s drug strategy by promoting preferred drugs to members and prescribers. 

TAC can make the whole experience faster and easier for members. 

MyPrime  

Members can take advantage of this capability by contacting Prime contact centers or on MyPrime. Prime’s contact centers utilize TAC to help members find the right medication over the phone.  On MyPrime, they can search a medication to see alternative medications covered on their formulary, as well as compare prices. Because Prime uses our own data and formulary information, TAC customizes the results based on their plan and formulary. 

How TAC reduces PAs 

Reducing PAs and denials creates an easier experience for members to get the medicine they need and saves prescribers time while helping them find the right prescription for the individual patient. By integrating TAC to the Clinical Operations Review Engine, Clinical Operations reviewers will not have to navigate to a different application to find drug alternatives, creating a faster review process. Ultimately, Prime will integrate drug alternatives into the electronic prior authorization (ePA) process enabling prescribers to receive drug alternatives before submitting an ePA request. This helps promote Prime’s preferred drugs, encourages formulary adherence and improves the experience by eliminating a PA denial.  

For health plans, reducing the administrative cost of PAs is always a positive, but it goes further than that. TAC can be integrated with the plan’s mobile app, further promoting the plan’s drug strategies by putting more information in the hands of members.