Services + Solutions | Medicare

Our experienced teams work hand-in-hand with our clients to help develop strong Medicare programs.

Section divider

People are our priority

People are our priority

Our programs and processes are designed to align with Centers for Medicare and Medicaid Services (CMS) requirements. We’re built to improve health outcomes and manage costs in a regulated environment.

  • More than 1.1 million Medicare Part D members
  • Serving 12 Medicare Part D plans in 16 states
  • 300+ Prime employees dedicated to Medicare
Section divider

Balancing affordability and access

Prime’s network strategy is designed to improve plan savings while helping members get the medicine they need. These innovative solutions for Medicare result in quality-based access and affordability.

Formularies play a key role in driving positive health outcomes and controlling costs. We work hard to develop formularies that combine the most clinical relevance and the lowest net cost to our clients, while meeting CMS requirements.

Balancing affordability and access

Section divider

Operations and compliance excellence

Operations and compliance excellence

Our management model is focused on operational compliance. It supports clients with data and metrics. And it’s one of the keys to our success in the Medicare business.

  • Constant monitoring of regulatory updates allows for timely responses to changes.
  • Compliance initiatives are integrated into all Medicare processes.
  • Internal and external audit protocols assess potential risks and vulnerabilities.
  • Processes designed to align with CMS requirements.
Section divider

Superior clinical programs and quality management

We lower costs, not quality. It’s the foundation of our Medicare approach. With 10+ years of experience in the market, we know that’s the way to be successful. We help lower costs for clients and members by:

  • Improving network savings through increased use of preferred networks.
  • Developing custom formulary options with flexible benefit designs.
  • Tracking and acting on market competitive intelligence to build better networks.


Reporting and analytics

We work closely with each client to build the right analytics capabilities. Once we’ve laid the groundwork, clients have access to powerful reporting and plan analysis through our interactive online reporting tool.