Prime Therapeutics ups its predictive analytics game with differentiated integrated data platform

EAGAN, Minn. — Prime Therapeutics LLC (Prime) introduces Insights+, its highly consultative data and analytics platform that gives clients timely access to their integrated medical and pharmacy data. The newly designed Insights+ incorporates Prime’s flagship analytics tool combining pharmacy and medical tools into one. Powered by the Artemetrx platform, Insights+ adds new functionality that enables streamlined data retrieval and analysis. Previously available to commercial clients, now Insights+ will serve select self-insured employer groups (through participating Blue Plans). This platform now transforms data into action, providing enhanced value beyond common PBM products. Interventions spurred by this predictive data have the potential to create cost avoidance savings to clients in the millions of dollars and help members achieve substantial savings as well.

Insights+ aggregates the delivery of data and expert knowledge in a unique way to organize and manage the rapid rise in the use of specialty drugs and a variety of other drugs, such as diabetes treatments. The level of detail available through Insights+ includes overall drug cost trends and client-specific opportunities, as well as drill-down capabilities. With guidance from Prime experts, clients use this intelligence to enact changes leading to efficiencies and appropriate therapy use. Insights+ replaces current manual, time-intensive processes. Insights+ is a primary component of a Prime product offering in development, designed to deliver guaranteed savings.

Predicts high costs before they occur

Insights+ provides a view into the impact of future high-cost trends and their resulting cost if left unchecked. A predictive model embedded in the enhanced tool identifies members spending more than $250,000 in drug spend and provides monthly reports and recommendations for potential care management, comprehensive medication reviews or other interventions by the client.

A monthly predictive high drug-cost member (i.e., drug super spender) report will show the current number of members and will predict how many members are expected to have at least $250,000 in drug claims costs in the next year. Insights+ can also predict what drugs, drug categories and chronic conditions lead to a member accruing $250,000 or more in annual drug expenses.

Prime’s expert consultants help identify drug cost avoidance opportunities so clients can intervene with members who are new to receiving a high-cost therapy. For example, one client’s member was using two high-cost branded drug therapies for hereditary angioedema. The Blue Plan used this knowledge to coordinate with providers, switch the member to lower cost drugs, and improve member drug use education, ultimately creating a $750,000 annual savings opportunity. Additionally, another Blue Plan realized an annual savings of more than $460,000 by eliminating the monthly shipment of a duplicate weight-based medication kit by coordinating with a patient’s physician.

“Insights+ is the gold standard for total drug spend management. It allows quick access to current high drug-cost member trends and a method to predict future costs early so we can quickly deploy high-touch care management,” said Steven Johnson, vice president of health outcomes for Prime. “Prime’s been on the leading edge of predictive analytics, and now with Insights+, for the first time, Prime experts and clients can make money-wise decisions by seeing how likely clients are to have high drug-cost members and what the cost could amount to in 12 months-time.”

Johnson added, “There’s great energy around clients maximizing this innovation. Some Blue Plans have said what once took multiple teams a span of weeks or even months to complete can now be accomplished in two to three clicks, freeing pharmacists and health care analysts to focus on other core responsibilities.”

Blue Plans see value in the Insights+ actionable data to help them identify savings opportunities at a member level each month. This predictive data enables plans to quickly implement medical policy that can improve costs for all members dealing with costly or chronic conditions.

“Insights+ is a must-have tool for navigating the web of pharmacy and medical claims,” said Molly Borchardt, Manager, Specialty Pharmacy at Blue Cross NC. “The new look and feel makes it even more simple to quickly identify ways to better manage high-cost specialty drugs and curb trends that create waste. The first year we leveraged the intelligence from Prime’s tool, we saved more than $3 million, and we didn’t have to wait a year to learn an expensive lesson. With an ever-growing pipeline of specialty and rare disease drugs, we’re grateful for this valuable resource.”

As the specialty drug pipeline brims with revolutionary therapies – many of which are billed under the medical benefit – Prime continues to refine Insights+ to meet client-specific needs. Prime will expand Insights+’s capabilities to reach a broader swath of Prime clients.