Prime reimagines patient care, unites care team for a better experience and smarter treatment plan

The patient journey from a cancer diagnosis through treatment with multiple specialty medications is often fraught with barriers created by a fragmented system – one that has potential to impede an optimal care plan. Enter Prime Therapeutics’ revolutionary IntegratedRx® program, a promising model of care that has potential to improve patient outcomes, reduce costs and improve patient satisfaction. In fact, patient satisfaction scores are up to two times better than with a traditional central fill model.¹

IntegratedRx – Oncology is a medically integrated dispensing (MID) model of care in which oncology practices dispense oral anticancer drugs at their practices in onsite pharmacies. MID has been shown to have several potential benefits for patients, including:

• Better care coordination and patient monitoring, allowing oncologists and pharmacists to work together more closely to monitor patients’ medication use and provide support for adherence. This may help improve patient outcomes and reduce the risk of adverse drug events.
• Reduced time from diagnosis to treatment by leveraging the integrated pharmacy team, reducing time to fill by as much as 80%². This can be particularly important for patients who are newly diagnosed with cancer or who are starting new treatment regimens.
• Lower barriers to medication uptake and adherence and improved medication management as a result of real time electronic medical record (EMR) access.
• Avoided toxicities and adverse drug reactions by providing pharmacists with the opportunity to review patients’ medication regimens and identify potential problems such as serious side effects from their medications. Less toxic reactions can mean fewer hospital visits, resulting in patient savings and better quality of life.
• Reduced costs: From January 2023 to April 2023, Integrated Rx – Oncology has generated savings of $4.6 million – or more than $2,000 per utilizing member – and total savings in 2023 is expected to exceed more than $10 million.³
• Waste reduction opportunities as care providers – including doctors and pharmacists – have access to prescribing history, test results and other important patient information in the EMR. This coordination informs the care team earlier than the traditional model and has potential to help lower the number of 30-day prescriptions going to waste.

Jaqui was a patient participating in the IntegratedRx program. Jaqui shares her experience from diagnosis through treatment.

In a study of Prime’s MID pilot program, waste – due to medication overfills – occurred in 29% of MID dose changes and 50% of central specialty pharmacy dose changes, resulting in an average cost of $937 and $2,733 per dose change at the MID and specialty pharmacy, respectively, for a specialty pharmacy average dose change additional cost of $1796.

And a recent Prime study looked at members utilizing both MIDs and specialty pharmacies (SP), and found that among MID claims, there were 106 dose changes with an average of $2,301 waste per dose change. Among SP claims, there were 1,037 SP dose changes with an average of $3,333 waste per dose change. Waste occurs in 47% of MID dose changes with an average cost of $4,878 per waste event, compared to 55 percent of SP dose changes with an average cost of $6,021 per waste event. The study finds that oral oncolytic waste tends to occur less frequently among MID pharmacies, and if the 1,037 oral oncology therapies dispensed by SP had been dispensed at a MID pharmacy, $1.1 million may have been saved.

In addition to these potential benefits, MID can also help to improve patient satisfaction and reduce the cost of care. A study by the National Community Oncology Dispensing Association (NCODA) found that 95% of patients who receive medications through an MID are satisfied or very satisfied with the experience. The study also found that MID can save patients an average of $1,000 per year on their medication costs.

Prime’s vision for reimagining pharmacy

Prime sat down with Chief Medical Officer Joseph Leach, MD, to understand where IntegratedRx fits into the company’s overall strategy and its unique model aimed at creating a more connected health care continuum while putting people – not profits – first.

Prime: How is IntegratedRx a revolutionary care/dispensing model?
Joseph Leach, MD (JL): The traditional PBM model is based on driving specialty prescriptions, including in oncology, to an owned central fill pharmacy. IntegratedRx leverages the advantages in improved care, improved member and provider experience and reduced cost that can uniquely occur in the integrated dispensing model in oncology. We fully believe in the potential of improved outcomes when we partner with providers, and this is a good example of that commitment. No other PBM has embraced this model like Prime.

Prime: What Prime values are the foundation for IntegratedRx? Where does it fit in the company strategy?
JL: Our company was built on the principle of doing all we can to improve the health and experience of our members. We don’t have to worry about reporting earnings to Wall Street so that gives us the latitude to pursue strategies like IntegratedRx. This won’t maximize our profit, but it will maximize clinical outcomes while reducing cost of care for our members and Blue plan owners.

Prime: Where’s Prime headed with its connected care model? What’s next?
JL: IntegratedRx is one way we’re bringing together the brightest minds in the industry to reimagine pharmacy management, providing the same care we would want for our loved ones. This is coming to life as we envision a more member-centric specialty care model that improves the patient experience from when a medicine is prescribed to when it’s filled, all while we eliminate complexities and reduce waste. Receiving new specialty medications and ensuring consistency pose challenges for members and caregivers. So, we strive to smooth the way for those experiencing emotions and stress that are often compounded by the complexity of traditional pharmacy delivery.

Prime: What crucial role does Prime as a PBM play in ensuring patients get the right care at the right time and in the right place?
JL: Specialty drug management has become increasingly complex, both for payers and providers. Prime is laser focused on exploring every avenue that we can to improve the member experience and maximize the clinical benefits of these innovative drugs while being mindful of the rising cost of health care. We will continue to pursue innovative partnerships like IntegratedRx that help us achieve those goals.

Prime’s IntegratedRx® solutions provide a better experience for people with certain complex conditions, promoting faster treatment start times, lower drug costs and coordinated care between providers and pharmacists. In addition to its Oncology program, Prime now offers IntegratedRx for patients undergoing treatment for cystic fibrosis. In its first year, IntegratedRx – CF has generated savings of more than $9,700 per utilizing member.² 

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As senior vice president and chief medical officer at Prime Therapeutics, Joseph Leach, M.D., is responsible for providing clinical leadership and expertise to the enterprise, informing and influencing internal and external stakeholders about Prime’s specialty and total drug management capabilities, contributing to innovation in these capabilities and driving client growth.

Dr. Leach, a medical oncologist with University of Minnesota Physicians, joined Prime with more than 20 years of experience as a clinician, researcher and health care leader. Active in clinical research, Leach has held numerous national leadership positions in research, including service on the National Cancer Institute Thoracic Malignancy Steering Committee and several roles with the Eastern Cooperative Oncology Group, which was one of the first publicly funded cooperative groups to perform multi-center clinical trials for cancer research.

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1. Zitter Health Insights. 3Q2019 specialty pharmacy patient satisfaction survey results.
2. Academia E. et al (October 2021), Adherence to oral oncolytics filled through an internal health-system specialty pharmacy compared with external specialty pharmacies, JMCP.org, Vol. 27, No.10.
3. Prime internal data.