Prime Insights


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February 19, 2020

Give up on biosimilars? Never!

The market has reached a biosimilar tipping point; One drug class is delivering millions in cost savings for Prime's Blue Plan clients. Read more

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Feb. 13, 2019 | By Catherine I. Starner, PharmD, BCPS, Senior Principal Consultant, Health Outcomes

Never again should you doubt the power of benefit design

A point of sale edit at the pharmacy shortened opioid prescriptions to less than seven days supply. Read more


Dec. 19, 2019 | By Pat Gleason, PharmD, FCCP, FAMCP, BCPS | Assistant Vice President, Health Outcomes 

Mind the gap: Using a drug’s price-to-value calculation

Prime applies a price-to-value framework for high cost drugs. This helps drive a productive dialogue based on the value a drug can deliver to a patient’s life. Read more


Dec. 9, 2019 | By Pat Gleason, PharmD, FCCP, FAMCP, BCPS | Assistant Vice President, Health Outcomes 

Small in number, but large in impact, “drug super spenders” need super attention

Just 0.03 percent of members have annual drug costs over $250,000. They account for 9 percent of total drug spend. Read more


Dec. 2, 2019 | By Stephanie Dauer, PharmD, MS, MBA, RPh, Senior Director, Clinical Program Development 

Prime continues to build its predictive modeling tool

Predictive modeling helped point to Medicare members whose medication use would likely improve with a pharmacist consultation. Read more


Nov. 25, 2019 | By Pat Gleason, PharmD, FCCP, FAMCP, BCPS | Assistant Vice President, Health Outcomes

Getting drug manufacturers to put more than product on the line

Ultra high-cost drugs and gene therapy are changing the face of value-based contracting. Here again, Prime’s business model makes us an innovator. Read more


July 15, 2019 | By Pat Gleason, PharmD, FCCP, FAMCP, BCPS | Assistant Vice President, Health Outcomes 

Point-of-sale intervention targets high-risk members 

The retail pharmacy, the health plan and the pharmacy benefit manager (PBM) worked together on behalf of members. And it worked. Read more


July 9, 2019 | By Pat Gleason, PharmD, FCCP, FAMCP, BCPS | Assistant Vice President, Health Outcomes

Building a crystal ball with pharmacy claims (predictive modeling) 

Artificial intelligence helped Prime build its predictive models for potential high dose opioid use. It’s one of the ways we give our health plans the tools to fight the opioid epidemic. Read more


June 28, 2019 | by Jo-Ellen Abou Nader, Vice President, FWA and Supply Chain Optimization

Integrated medical and pharmacy data helps identify opioid FWA

Looking for fraud, waste and abuse (FWA) using integrated data is where we can make a difference in fighting the opioid epidemic. Read more


June 12, 2019 | By Catherine I. Starner, PharmD, BCPS, Senior Principal Consultant, Health Outcomes

Managing hope for those with spinal muscular atrophy

Use of Spinraza® is ramping up. And newly approved gene therapy Zolgensma®  will change the treatment landscape even more. Read more


May 31, 2019 | By Catherine I. Starner, PharmD, BCPS, Senior Principal Consultant, Health Outcomes

How much is too much?

Treatments for cystic fibrosis can cost about $300,000 a year. The high cost of specialty drugs is creating a need for price to value conversations. Read more


May 6, 2019 | By Pat Gleason, PharmD, FCCP, FAMCP, BCPS | Assistant Vice President, Health Outcomes

Everything you wish you knew about the autoimmune category, but didn’t know who to ask

Your autoimmune trend: it’s not just about rheumatoid arthritis. Managing autoimmune trend means making tough decisions. It’s best done with all the facts at hand. Read more


April 22, 2019 | By David Eckwright, Health Outcomes Research Principal and Brett Sahli, Senior Director, Specialty & Clinical Consultative Services

Research on Botox use for migraines shows big drop off rate

But hang on: migraine sufferers who don’t find relief from the typical drug classes may now benefit from a new class of therapy. Read more


April 15, 2019 | By Pat Gleason, PharmD, FCCP, FAMCP, BCPS | Assistant Vice President, Health Outcomes

Come on in, the water’s fine

No need to be nervous about adopting a narrow formulary when it’s done right. NetResults delivers $11-14 PMPM pharmacy savings and our study shows no increase to medical costs. Read more


April 8, 2019 | Prime Therapeutics

Medical drug management – the Prime model

By Rae McMahan, Vice President and General Manager, Prime Enterprise Specialty

Our holistic approach includes a four-part model for managing drug across the medical and pharmacy benefits. Take a look at the Prime model | Applied to infliximab | Applied to Solaris | Biosimilars for neutropenia


April 1, 2019 | By Steve Johnson, PharmD | Vice President, Health Outcomes

New tool brings more savings opportunities into focus

In today’s complex world, Prime’s new Specialty Monitor offers health plans an edge they didn’t have before. It displays more savings opportunities, faster. Read more


March 26, 2019 | By Rae McMahan, Vice President and General Manager, Prime Enterprise Specialty

Biosimilars could make a big difference for neutropenia

New-to-market biosimilar options can save millions of dollars and still provide quality of care for patients. But it takes medical drug management. Read more


March 19, 2019 | Prime Therapeutics

Prime Therapeutics keeps high-cost drug trends at bay

Prime released its annual trend reports in March. Drug management offerings added savings value of nearly $3.4 billion for health plan clients in 2018 according to the company’s annual drug trend results.  Commercial   Medicare Part D   Medicaid


March 18. 2019 | Prime Therapeutics

Building Prime's knowledge base about members with diabetes

Members with diabetes often have other conditions as well. How does that affect their health care? Prime's research over many years helps to build a picture of what that looks like. Read more


March 11, 2019 | By Rae McMahan, Vice President and General Manager, Enterprise Specialty

New strategies are indicated for new Soliris indications

Prime's total drug management solution includes medical drug management. Our goal, always, is healthy outcomes and lowest net cost. Read more


March 6, 2019 | By Kevin Bowen, MD, MBA, Principal Health Outcomes Researcher

Teaching our members with diabetes how to juggle

Most people with diabetes have other conditions as well. Can we improve the way they manage many conditions at the same time?  Read more


Feb. 27, 2019 | By Rae McMahan, Vice President and General Manager, Prime Enterprise Specialty

Infusion and income: The ins and outs of infliximab

Medical drug management: the savings may surprise you. If it were easy, you’d have done it yourself already. Read more


Dec. 27, 2018 | Prime Therapeutics

Delivering specialty solutions with a patient-centered approach

 “I was holding a vial in my hand worth more than $3,000. This is what a patient with a specialty condition has to deal with every day." Patient-centered specialty solutions for hereditary angioedema (HAE) use research from integrated claims and clinical expertise. Read more


Dec. 17, 2018 | Prime Therapeutics

Taking all factors into consideration

Prime’s research last year into new extended half life (EHL) factor products produced unexpected clinical results for members with hemophilia A. Prime worked with Blue Plan clients to implement recommendations based on specific market needs. Read more


Dec. 3, 2018 | Prime Therapeutics

Biosimilars – overcoming brand bias and misperceptions

Most patients with cancer develop neutropenia (due to chemotherapy). There are now multiple biosimilar options for the drugs that treat neutropenia. Can we move the market to biosimilars?  Read more


Nov. 19, 2018 | Prime Therapeutics

Location, location, location (site of care really does matter)

Autoimmune drugs top the list of drugs in specialty drug spend. Managing site of care doesn’t mean moving drugs from the medical benefit to the pharmacy benefit. Read more


Nov 6, 2018 | Prime Therapeutics

Helping patients with severe asthma breathe easier

Recent drugs launched to treat severe asthma work in different ways against different biomarkers. Now it's important  to find ways to make sure those drugs are used by the most appropriate patients – those who can benefit from these effective but expensive therapies. Read more


Sept. 7, 2018 | by Shannon Kampa, PharmD, MBA, Senior Director, Medicare Clinical Program Management 

Using an extra tier to add a new adherence tool 

When Prime lowered member cost share for generics in targeted categories, member adherence went up for our Medicare clients. Read more


Sept. 7, 2018 | By Stephanie Dauer, PharmD, MS, MBA, RPh, Director, Medicare Clinical Program Development 

Prime's missed refill program is a hit with Medicare plans

A two-touch rapid response program helps nudge members to refill their prescription.  Read more


June 30, 2018 | By Pat Gleason, PharmD, FCCP, FAMCP, BCPS | Assistant Vice President, Health Outcomes

Small populations, big dollars

Hemophilia.  Myasthenia gravis.  Heriditary Angioedema.  These conditions are rare, challenging to treat and difficult to live with. And the annual drug therapy price tag for members for these conditions can top $1 million. With stakes this high, specialty drug management becomes even more important. Read the series: Part 1: Hemophilia  |  Part 2: Myasthenia gravis  |  Part 3: Heriditary Angioedema


April 30, 2018 | Prime Therapeutics

Pharmacist integration delivers big results

Blue Cross & Blue Shield of Rhode Island (BCBSRI) started funding pharmacists in physician practices in 2014. Within three years, the program helped avoid $23 million in health care costs (commercial and Medicare). See how that worked in this four-part series. Part 1 | Part 2 | Part 3 | Part 4


June 15, 2018 | By Cathy A. Starner, PharmD, BCPS, Senior Principal Consultant, Health Outcomes

Reducing opioid use among outliers; are we doing enough? 

Prime’s opioid research demonstrates our ability to identify and impact members whose opioid use puts them outside the norm. Do you know who they are and what impact they could be having on your business? Read more


Dec. 27, 2017 | By Kevin Bowen, MD, MBA, Principal Health Outcomes Researcher  

Rheumatoid Arthritis: We dig deeper for insights that make a difference

Prime’s analysis of integrated medical and pharmacy data gives us insights into whether members are getting the most effective treatment for rheumatoid arthritis (RA), according to clinical guidelines. Following clinical guidelines improves the standard of care. 

RA infographic | Part 1: What is RA and why is it important? | Part 2: The role of csDMARDS and b/tsDMARDS in treating rheumatoid arthritis (RA)  | Part 3: What can a PBM and plan sponsor do to help?


March 29, 2018 | By Patrick Gleason, PharmD, FCCP, FAMCP, BCPS, Assistant Vice President, Health Outcomes

Assigning the right value to value-based insurance design

Does value-based insurance design (VBID) work? Pat Gleason has studied pharmacy benefit health insurance for many years. He’s linked medical and pharmacy claims data to look for outcomes; he’ll provide some insights on VBID strategy. Read more


Feb. 20, 2018 | Prime Therapeutics 

Prime’s 2018 drug trend represents the second consecutive year of outstanding results 

In 2017, clients across all lines of business — commercial, Medicaid, and Medicare Part D — saw lower overall spending on prescription drugs (per member per month) when compared to 2016. These negative trend numbers prove Prime’s value. See individual reports by business line: Commercial | Medicare Part D | Medicaid | News release summary


Dec. 12-27, 2017 | By Patrick Gleason, PharmD, FCCP, BCPS, FAMCP, Assistant Vice President, Health Outcomes

Gene therapy opens new worlds in health care  

This four-part series explores some of the near- and long-term implications of gene therapy treatment. 

  1. Kymriah™ launches great expectations
  2. Rewrite the textbooks; treating disease has been turned inside out
  3. Today’s drugs: What’s the investment in time and money from idea to market?
  4. Gene therapy will redefine health care

Nov. 14, 2017 | Prime Therapeutics

Specialty drug spend forecast: The stakes are high  

Five years ago, Prime predicted specialty drugs would hit 50% of total drug spend by 2018. Looks like we were right. Now, we predict it will hit 60% by 2021. Check out our latest specialty infographic

Insights with Impact: managing diabetes costs with data 

Prime looks beyond diabetes drugs to address the total cost of diabetes care

Insights with Impact: managing diabetes costs with data 

Prime looks beyond diabetes drugs to address the total cost of diabetes care

Insights with Impact: managing diabetes costs with data 

Prime looks beyond diabetes drugs to address the total cost of diabetes care


Oct. 31, 2017 | By Cathy Starner, PharmD, BCPS, Senior Principal Consultant, Health Outcomes

America’s opioid epidemic: A public health emergency 

A look at the opioid epidemic from a managed care perspective. Prime’s programs have lowered opioid use 15 percent over the last five years. How do we keep moving forward?  Part 1 |  Part 2  |  Part 3  |  Part 4Part 5  


Sept. 27, 2017 | Prime Therapeutics

The Drug Pipeline Impact Series 

Over the last five years, the increase in drug costs has been unprecedented. This four-part series will help you understand some of these changes, and how Prime continues to deliver consistent value. Part 1 | Part 2 | Part 3 | Part 4

Insights with Impact: managing diabetes costs with data 

Prime looks beyond diabetes drugs to address the total cost of diabetes care

Insights with Impact: managing diabetes costs with data 

Prime looks beyond diabetes drugs to address the total cost of diabetes care

Insights with Impact: managing diabetes costs with data 

Prime looks beyond diabetes drugs to address the total cost of diabetes care


May 10, 2017 | Prime Therapeutics

Insights with Impact: managing diabetes costs with data 

Prime looks beyond diabetes drugs to address the total cost of diabetes care. Read about study.


May 3, 2017 | Prime Therapeutics

Insights with Impact: more data isn’t better data

Why Prime’s adherence predictors top bulk consumer data.  Read about the study


April 26, 2017 | Prime Therapeutics

Insights with Impact: Different, but not just to be different

Being different is only better when it makes a difference.  Read about the two studies


April 27, 2017 | Prime Therapeutics

Insights with Impact: Pharmacist interventions

Research proves people do make a difference. Learn about the effects of pharmacist interventions on specific high-risk populations.  Read about two studies


April 6, 2017 | Prime Therapeutics

Prime releases 2017 Drug Trend Reports

Prime is creating partnerships and programs that will reshape the PBM industry. These reports illustrate the powerful results that this work can generate.  Get the highlights


Nov. 11, 2016 | Prime Therapeutics

Managing accelerating autoimmune drugs costs across benefits is critical

Just 5 in every 1,000 members use autoimmune drugs. Yet it’s the most expensive drug class under both the medical and pharmacy benefit — and one of the fastest growing.

Prime's latest autoimmune drug research


Nov. 11, 2016 | Prime Therapeutics

Infographic: Drug pipeline profile: Duchenne muscular dystrophy

New  therapies for this rare disease are in pipeline, and they could have a big impact on drug costs — up to $4.57 per member per year.  DMD and what’s on the horizon


Aug. 31, 2016 | By Patrick Gleason, PharmD, FCCP, BCPS, FAMCP, Assistant Vice President, Health Outcomes

Prime research decodes top Stars-related adherence predictors by category

Prime explores the top predictors of future adherence for three key Star ratings drug categories — high blood pressure, high cholesterol and diabetes — based on a recent study of more than 1.1 million Medicare members. Top adherence predictors by category


Aug. 24, 2016 | By Patrick Gleason, PharmD, FCCP, BCPS, FAMCP, Assistant Vice President, Health Outcomes

Can big data help boost medicine-related Star ratings?

Prime performs adherence predictive modeling, using big data, to provide evidence-based recommendations to drive higher ratings for Star-related drug categories.  Top predictors of adherence


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