Company information
September 24, 2021We are reimagining pharmacy management to provide the same care we would want for our loved ones. We’re building the pharmacy solutions company of the future by leveraging our strong foundation, adapting to the evolving market and improving the way pharmacy services are provided.
Prime at a glance
Formed in 1998 by two Blue Cross and Blue Shield plans, Prime has grown steadily to become the fourth-largest pharmacy benefit manager in the nation – and partner of choice for 19 Blue Plan owner clients. Because we are a privately held company owned by not-for-profit health partners, we have the rigor and freedom to remain nimble and focus on the best long-term solutions that improve health outcomes and affordability for our members, the more than 92 million people we serve.
We know there is true power in those who are passionate about evolving and improving the health care experience. With our acquisition of Magellan Rx, we have brought together some of the brightest minds in the industry — visionaries with the skills and passion to push boundaries as we create a new, higher standard, tackle the toughest challenges our industry faces and shape the future of health care.
Our enterprise is organized across three lines of business:
- Pharmacy benefit management: As an independent industry leader providing pharmacy management solutions in the health plan and employer markets, we create exceptional experiences for our customers and their members by driving real value across the drug supply chain. Our differentiated solutions and clinical expertise simplify the health care experience and positively impact total cost of care.
- Specialty solutions: We are the market-leading specialty drug management experts, serving 33 million specialty members, 16 million medical pharmacy members and more than 50 health plans. We deliver innovative, clinically driven, comprehensive solutions through a future-focused lens that helps us improve care, stay ahead of trend and reduce specialty spend across both pharmacy and medical benefits.
- State government solutions: With 25+ years serving state customers, we support 28 states and DC with Medicaid and state pharmacy administration programs. We deliver affordable and reliable solutions to meet unique population needs, improve clinical outcomes and ensure coordination of care, providing the states’ most vulnerable members access to the tools and resources they need to live healthier lives.
Our operations
Drug spend managed
2021 $37.4 billion
2022 $36.7 billion (estimated)
Annual claim volume
2021 398 million
2022 424 million (estimated)
We work across the health care industry to deliver pharmacy solutions that create exceptional experiences for all stakeholders. As we seek to simplify the health care experience, we:
- Collaborate with pharmaceutical manufacturers to positively impact health outcomes through education for products and disease states and partner to deliver drug access and patient assistance programs
- Connect with providers to ensure coordination of member care, including a dedicated provider relations team in our specialty division
- Work with employer groups, health plans and state governments to manage and administer pharmacy benefits
- Partner with payers to manage specialty drug spend
Care + medicine = improved outcomes
With prescription drugs now accounting for more than 30% of total health care costs, Prime’s role as a strategic partner has never been more tangible or important. What’s more, Prime provides members with a holistic care journey, integrating providers, patients and channels — and uncovering insights that can make people’s lives better.
- Collaborations with stakeholders like Amazon Pharmacy and Express Scripts® mean Prime clients and members get the most competitive prices available for the medicines they need.
- Clinical programs integrate data analytics with customized outreach, including personalized interventions from pharmacists, to help members and prescribers make the best drug management decisions.
- Prime uses the power of its own predictive data, combined with data from its Blue Plan partners, to create actionable insights and tackle the toughest Rx challenges, ultimately helping improve outcomes for members.
- Prime’s High Value Pharmacist pilots earned the 2021 Excellence Award from the Pharmacy Benefit Management Institute.
- Prime’s fraud, waste and abuse program saved health plan clients $285 million in 2020 and earned the #2 spot among health care companies on Fast Company’s “Most Innovative Companies List.”
- In 2022, Prime published its first diversity, equity and inclusion transparency report, demonstrating progress in workplace and community equity, acknowledging the meaningful steps taken and still required to achieve a more diverse, inclusive way of doing business.
- Prime’s IntegratedRx program employs a channel-independent approach to help identify solutions that drive the best financial and quality outcomes for Blue Plans and members.
Leading the way
We help our partners stay ahead of growing spend and deliver the best experience for their members by providing a comprehensive suite of targeted products and programs that help drive down costs and improve member health.
Prime has a deep understanding of pharmacy trends, including one of the largest specialty cost drivers: specialty drugs dispensed through the medical benefit. With 2% of members driving 50% of total pharmacy spend – and half of that spend residing on the medical benefit – our partners need solutions to effectively manage total specialty costs.
And we’re focused supporting the member experience by helping our customers and their members make well-informed decisions that will deliver on their goals and health outcomes.
Locations and employees
Headquarters: Eagan, Minnesota
Regional location(s): Orlando
Employees: 6,900+