Prime Therapeutics introduces HighTouchRx® pharmacist outreach program using both medical and pharmacy data to help maximize savings

EAGAN, Minn. –  Leading pharmacy benefit manager (PBM) Prime Therapeutics LLC (Prime) announces the launch of HighTouchRx®. The award-winning program applies machine learning analytics to integrate medical and pharmacy claims data resulting in drug therapy optimization opportunities. These savings opportunities are worked by specialized pharmacists within the Blue Plan or in collaboration with Blue Plans through outreach to prescribers.

Specialty drugs are the fastest growing expense within the pharmacy benefit and are commonly the fastest growing medical benefit expense category now accounting for 53% of drug spend.¹ At Prime, only 1% of members make up 50% of drug spend totaling over $12 billion,² of which up to $2 billion may be non-optimized³. “The cost of managing and taking specialty medicines are a heavy burden on our entire health care system,” said Joseph Leach, MD, chief medical officer for Prime and a practicing oncologist. “We’re here to help alleviate that.”

Additionally, because specialty drugs have high unit costs, are found on both the medical and pharmacy benefits, have complex dosing/treatment regimens that change over time, and carry the potential for fraud, waste and abuse (FWA), their use requires close oversight and review by pharmacists with access to integrated claims data. This white-glove treatment helps tackle rising costs by evaluating more than 1,000 medical and pharmacy clinical rules including:

• Duplicate therapy
• Off-label use
• Biosimilar availability
• Dosing monitor constant surveillance and outlier notification
• Site of care management
• Brand to generic optimization
• New drug approvals

The HighTouchRx program is flexible to meet the needs of health plans that have the option to:

1. Deliver Prime’s full-service option that uses Prime-employed pharmacists to perform analysis and conduct prescriber outreach. This approach has a performance guarantee for participating health plans.
2. Access Prime’s new, web-based portal and rules engine for their own Blue Plan pharmacists to complete the prescriber outreach.

Both options include a dedicated team of Prime data scientists and pharmacists using continuous quality improvement processes and incorporating pharmacists in the field to prioritize the outreach opportunities. Additionally, the robust analytics dashboard reports opportunities and savings down to the employer level in a user-friendly format.

“With HighTouchRx, Prime’s data analytics engine is uniquely able to pinpoint small changes and new approaches that can optimize drug therapy and remove waste from the health care system, leading to significant savings and help manage specialty medicine spend,” Leach added. “Specialty medicine management can be complicated, so this high touch approach – using machine learning applied to medical and pharmacy benefit information with the Blue Plan and Prime collaboration – helps lower the total cost of care.”

Previous successes

Prime successfully piloted similar offerings with two health plan partners:

• One study showed savings of a net $2.4 million in health care costs in one year.
• A second study analyzed the success of drug therapy programs where managed care pharmacists recommend drug therapy optimization with members and providers. It delivered $7.8 million in net cost avoidance.

In one previous pilot, a Prime pharmacist uncovered a member with hereditary angioedema (HAE) who used multiple HAE medications unnecessarily. The pharmacist contacted the prescriber and care team of the medication duplication. This led to the discontinuation of one medication, while the member remained on one safe and effective preventative HAE medicine and acute treatment medication. Combined, the member and health plan had a three-month savings of $276,000.

1. The use of medicines in the U.S. IQVIA. (n.d.). Retrieved October 25, 2021, from https://www.iqvia.com/insights/the-iqvia-institute/reports/the-use-of-medicines-in-the-us.
2. Prime internal data, 2021
3. When drugs are wrong, skipped or make you sick: The cost of non-optimized medications. UC Health – UC San Diego. (n.d.). Retrieved November 15, 2021, from https://health.ucsd.edu/news/releases/Pages/2018-04-02-when-drugs-are-wrong-skipped-or-make-you-sick-the-cost-of-non-optimized-medications.aspx.