Services + Solutions | Health plans

In a challenging marketplace, our dedicated government programs team stays ahead of state regulations and other market changes to help clients see profitable growth.

Section divider

Driving competitive exchange options

Rising prescription drug costs make it hard to achieve positive numbers in the health insurance marketplace (HIM).

In spite of the challenges, health plans want to give their members affordable exchange options. And Prime is helping them succeed.

We analyze both pharmacy and medical data to deliver total drug management solutions to our HIM clients — solutions that achieve the lowest net cost while still providing a high quality of care for their members.

Our HIM experts focus on state market competitiveness, benchmarking and innovative strategies to support our clients. Our formularies highlight clinical best practices, are competitive and financially stable, and meet state regulations. And our pharmacy-based risk adjustment strategies are industry leading.

Section divider

A leader in the marketplace

Prime is a leader in the HIM, with 21 HIM clients in 20 states, 2.5 million individual lives across federal and state exchanges. It also includes over 5.2 million individual and small group lives, on and off exchange (as of January 2019).

Section divider