REIMAGINE YOUR PHARMACY BENEFITS PARTNER
Built by health plans for health plans, we offer the next level of pharmacy benefit manager (PBM) partnership. Our PBM products, specialty and medical pharmacy solutions and Medicare and Medicaid expertise provide you and your members with a holistic, people-centric approach to care.
DIFFERENTIATED PARTNERSHIP
Providing flexibility, expertise and commitment
You deserve more than a one-size-fits-all solution, and so do your clients and members. Our unique privately held model allows us to focus on providing the same care we would want for our loved ones — and not on reporting to shareholders or Wall Street. We offer flexibility, truly customized partnerships and clinical expertise, all supported by a strategic team of account and subject matter experts. Ultimately, we’re focused on helping you find the pharmacy solutions, resources and strategies that best support your growth and retention efforts and the long-term health of your members.
Helping to lower drug costs
You’ll gain access to our award-winning, accredited solutions, including cost and formulary management strategies to help you and your members make informed health care decisions and lower costs for everyone.
Delivering holistic specialty solutions
With specialty drug costs continuing to climb, developing a holistic specialty drug management strategy across the medical and pharmacy benefits can help you lower costs and get ahead of trends.
Improving member experience and outcomes
Our clinical programs support medication adherence and help eliminate gaps in care. By helping your members get the medication they need when they need it, we help you improve health outcomes and reduce the total cost of care.
Discover how we help optimize drug access
Learn more about how we improve adherence
Providing industry-leading Medicare and Medicaid expertise
Our dedicated teams and innovative solutions support your efforts to meet — and exceed — Medicare requirements and CMS regulations. We also bring extensive knowledge of each state’s business and political climate and experience with Medicaid compliance to help you deliver industry-leading pharmacy services to your state Medicaid customers.
MEETING YOUR UNIQUE NEEDS
Driving savings through both an integrated and stand-alone approach
Your priorities matter to us. Whether you’re looking to integrate your data across pharmacy and medical benefits or seeking stand-alone solutions, we are flexible to support you and your business goals.
AN INTEGRATED APPROACH
We use integrated data to fuel our innovative pharmacy solutions, develop predictive models, distill actionable information and tackle the toughest industry challenges. A recent two-year analysis conducted by Blue Cross® and Blue Shield® of Minnesota and Prime shows how an integrated solution can lower medical costs an average of $422 per member per year and improve health outcomes compared to stand-alone models.
A STAND-ALONE APPROACH
For health plans desiring flexibility and a pharmacy-only partnership, we offer a customizable, stand-alone approach. We’ll work with you to design a pharmacy benefits plan that is cost-effective and tailored to your member population while still maintaining a holistic view of the patient health care journey.
HEALTH PLAN-FOCUSED RESOURCES
Expert knowledge from the brightest minds in pharmacy
Part of making smarter health care decisions is having access to all the information you need. As a service-centered PBM, we have a responsibility and the desire to share information and insights with you so you can make the best decisions.
Explore award-winning research on duplicate incretin therapies
We looked across our commercial population to target members who were taking duplicate GLP-1 and DPP-4 medications. Using our HighTouchRx® clinical solution, we reached out to providers and recommended single-agent therapies, helping to eliminate the risks of duplicate therapies and saving more than $3.5 million for our customers.
Driving greater use of biosimilars to help lower drug costs
Driving greater use of biosimilars to help lower drug costsBiologic drugs are changing people’s lives for the better, but often at a very high cost. Biosimilars are drugs that are highly similar to, and often less expensive than, their reference biologics, providing significant savings opportunities. As part of our total drug management strategy, we identify biosimilars in the pipeline and develop solutions that are ready from day one.
Developing a holistic GLP-1 strategy
Developing a holistic GLP-1 strategyWe take an evidence-based approach to GLP-1 drugs, working with our partners to develop individualized strategies that promote clinically appropriate use and consider total costs of care, long-term value and member health outcomes.