May 11, 2021
Prime Therapeutics proactive prescriber outreach significantly improves statin use in Medicare members with diabetes
Largest statin use improvement found when program is coupled with proactive pharmacist outreach.
EAGAN, Minn. – Using a proactive prescriber outreach program, Prime Therapeutics LLC (Prime), a pharmacy benefit manager (PBM) serving nearly 33 million members nationally, saw increased statin use in Medicare members with diabetes. According to the American Diabetes Association, 34.2 million Americans (10.5% of the population) have diabetes. 1 In the Medicare (age 65+) population, the prevalence is even higher at 26.8% of seniors.1 Statin therapy is recommended for most adults with diabetes based on their cardiovascular risk.2
Despite the availability of alternative messaging platforms and technologies, 90% of the health care industry still relies on fax machines.3 So Prime created a statin use in persons with diabetes (SUPD) prescriber fax program. This program identified members with diabetes who did not have a statin claim and sent a fax to the members’ prescriber(s) recommending statin medication therapy.
Prime has a total Medicare member population of 1.4 million members. For this GuidedHealth® program, the intervention group (N=58,237) included Medicare members who participated in the SUPD prescriber fax program, and a control group (N=21,517) included members who did not participate in the program.
There was a statistically significant (0.8 percentage point) larger increase in statin use among members with the fax program compared to the control group. SUPD is one of many measures used to calculate a single CMS Star Rating in Medicare Part C or D. However, this SUPD measure had greater importance as it was triple weighted at the time. Increasing SUPD also contributed to higher health plan Star Ratings.
Prime offers a variety of other programs to help health plans and employers manage members with diabetes. Coupling this SUPD prescriber fax program with its GuidedHealth Smart Adherence pharmacist outreach program, Prime saw a 1.2 percentage point increase in statin use when compared to the control group.
“Members with diabetes are a highly prioritized group for Prime,” said Stephanie Dauer, senior director, clinical program development at Prime. “Finding effective ways to manage their use of statins and successfully work with prescribers can result in better health outcomes and cost savings. Additionally, we were encouraged to see that when multiple Prime clinical programs are working together, even better results can be realized. Prime continues to evaluate the expansion of these clinical programs to our other lines of business.”
1. Statistics About Diabetes. Statistics About Diabetes | ADA. (n.d.). https://www.diabetes.org/resources/statistics/statistics-about-diabetes.
2. Health Checks for People with Diabetes. Health Checks for People with Diabetes | ADA. (n.d.). https://www.diabetes.org/diabetes/newly-diagnosed/health-checks-people-with-diabetes.
3. TigerConnect. (2019, November). The State of Healthcare Communications. https://pages.tigerconnect.com/rs/896-JSW-458/images/survey-state-of-healthcare-communications-tc.pdf.
About Prime Therapeutics
Prime Therapeutics LLC (Prime) makes health care work better by helping people get the medicine they need to feel better and live well. Prime provides total drug management solutions 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 nearly 33 million people. It is collectively owned by 19 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.
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