Press release

Sept. 10, 2018

Prime Therapeutics statement on CMS’ decision to allow indication-based formulary design  

New program begins in 2020 and focuses on formularies that cover specific drugs for specific indications.


ST. PAUL, Minn. – Prime Therapeutics LLC (Prime), a leading pharmacy benefit manager (PBM) serving more than 27 million members nationally, released the following statement in response to the Centers for Medicare & Medicaid Services’ (CMS) August 29 memo to Medicare Part D plans allowing plans to create indication-based formulary design – formularies that cover specific drugs for specific indications – beginning in 2020. This contrasts with CMS’ current policy under which health plans must cover every FDA-approved indication for a drug on its formulary for government program members.

“Prime supports this change for our Medicare segment as we currently apply indication-based formulary design in our commercial line of business and have also been implementing indication-based contracting with pharmaceutical manufacturers,” said Rachel Henely Nelson, Prime’s Vice President and General Manager, Federal Programs. “The goal of these activities is to maximize our negotiating power and provide plans additional flexibility and choice in formulary design. CMS’ policy change validates our current work it potentially gives us another avenue to support our efforts to drive affordability of medicines for our clients and members.”


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.

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