Services + Solutions | Medicaid

Our dedicated team of experts monitor state regulations, seek to improve health outcomes and aim to achieve lowest net cost to support Medicaid clients.

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Medicaid should be in your offering

Currently, 600 billion health care dollars are spent on Medicaid every year. Over 70 million Americans are enrolled in Medicaid. About half of all pregnancies in the United States are funded by Medicaid. In fact, there are more Americans in Medicaid than in Medicare and the health insurance marketplace (HIM) combined. That makes it a significant segment in the health care marketplace — and a big opportunity to gain new members.*

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We know our clients, their markets and their members

At Prime, we’re transforming how Medicaid is viewed within the pharmacy benefit management industry. We’re doing this through research and collaboration with our Blue partners, through outreach and intervention with Medicaid members, and by understanding the barriers Medicaid members face in their daily lives. It’s comprehensive Medicaid management, from a team that’s dedicated to helping lower costs and improving health outcomes.

Our Medicaid management team understands the unique needs of each state market, including all state and Centers for Medicare & Medicaid Services requirements, regulations and rules.

Prime also has a dedicated Government Affairs team that functions at the state and federal level. The team regularly reviews all current and pending legislation.

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Our programs check every box

Our total drug management approach includes consumer-centric innovations like missed refill and utilization management programs, controlled substance management and GuidedHealth®  ̶  all designed to promote adherence and create a better member experience. Our programs address barriers to care and meet member’s diverse needs.

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According to Prime's internal data

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