Services + Solutions | Medicare

We provide superior service to our clients through a dedicated Medicare team that focuses on better outcomes and managing rising drug costs.

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Total drug management solutions

Thanks to our Blue +Prime partnership, we can look at both pharmacy and medical data to deliver total drug management solutions to our Medicare clients. Our innovative solutions achieve the lowest net costs, while maintaining the highest quality of care for their members.

We work with each client to evaluate new market opportunities, including expansions, joint ventures, plus new products and services to ensure growth. Our innovative products help improve Medicare clients’ Star ratings. For example, Prime’s GuidedHealth® program helps members and providers make better decisions about members’ health. The program uses data and analytics to help improve health outcomes, increase safety and lower total cost of care.

Take a look at how two of our programs show that lower generic cost share and missed refill interventions may yield better health, higher Star Ratings.

We offer formulary management through a team of clinical professionals, plus accurate and timely Centers for Medicare and Medicaid Services reporting. And our Star ratings speak for themselves:

  • 4 clients achieved a 5-Star rating and 4 achieved a 4.5-Star rating on their Part D Summary*
  • Continued year-over-year improvement on the 3x Adherence scores (Diabetes, Hypertension and Cholesterol) *
  • Adherence rates have improved year-over-year since 2012. One intervention showed increases as high as 1.9%. **

* Centers for Medicare and Medicaid Services, 2019
** Prime internal data

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Superior partnership model

Prime was created by Blue Plans more than 20 years ago. That gives us a huge edge over our competitors. Our unique relationship allows us to share best practices and strategies with our Blue Plan clients that may face similar market challenges. That’s something health plans won’t get from other PBMs.

Collaboration creates timely products for Medicare markets

Balancing affordability and access

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