Prime Insights


PI_Migraine_Homepage_460x250A

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

Section divider

    Recent insights

April 15, 2019

Come on in, the water’s fine

by Pat Gleason,  PharmD, FCCP, FAMCP, BCPS

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

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

New tool brings more savings opportunities into focus

By Steve Johnson, PharmD | Vice President, Health Outcomes

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

Biosimilars could make a big difference for neutropenia

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

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 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

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 

New strategies are indicated for new Soliris indications

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

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 

Teaching our members with diabetes how to juggle

By Kevin Bowen, MD, MBA, Principal Health Outcomes Researcher

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

Infusion and income: The ins and outs of infliximab

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

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


Dec. 27, 2018

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

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

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

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

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

Using an extra tier to add a new adherence tool 

by Shannon Kampa, PharmD, MBA, Senior Director, Medicare Clinical Program Management 

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


Sept. 7, 2018

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

By Stephanie Dauer, PharmD, MS, MBA, RPh, Director, Medicare Clinical Program Development 

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


June 30, 2018

Small populations, big dollars

By Pat Gleason, PharmD, FCCP, FAMCP, BCPS

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

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 

Reducing opioid use among outliers; are we doing enough?  

By Cathy A. Starner, PharmD, BCPS, Senior Principal Consultant, Health Outcomes

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 

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

By Kevin Bowen, MD, MBA, Principal Health Outcomes Researcher 

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

Assigning the right value to value-based insurance design

By Patrick Gleason, PharmD, FCCP, FAMCP, BCPS, Assistant Vice President, Health Outcomes

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

Gene therapy opens new worlds in health care  

By Patrick Gleason, PharmD, FCCP, BCPS, FAMCP, Assistant Vice President, Health Outcomes

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

America’s opioid epidemic: A public health emergency 

By Cathy Starner, PharmD, BCPS, Senior Principal Consultant, Health Outcomes

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  

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


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 

Prime research decodes top Stars-related adherence predictors by category

By Patrick Gleason, PharmD, FCCP, BCPS, Assistant Vice President, Health Outcomes

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

Can big data help boost medicine-related Star ratings?

By Patrick Gleason, PharmD, FCCP, BCPS, Assistant Vice President, Health Outcomes

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


Aug. 2 2016

The CREATES Act: A viable solution for more affordable prescription drug choices

By Jonathan Gavras, MD, FCCP, Senior Vice President and Chief Medical Officer

Lawmakers are fighting for more affordable prescription drug choices for families. The CREATES Act can pave the way, and Prime Therapeutics is on board.

How the CREATES Act can help

Section divider