Prime’s Specialty Monitor® solution identifies $5 million in projected savings for Blue Cross and Blue Shield of North Carolina

Prime Therapeutics’ state-of-the-art, total drug management solution, Specialty Monitor®, powered by the Artemetrx platform, aggregates specialty medical and pharmacy claims data to identify patterns of high-cost drug use and waste in the health care delivery chain. Prime leads the industry as the only pharmacy benefit manager (PBM) providing invaluable insights in the form of comprehensive benefits data that can be filtered and reported in a myriad of ways. Since the rollout of Specialty Monitor last year, Prime’s health plan clients have identified millions of dollars in savings opportunities by acting quickly upon actionable insights to curtail drug misuse and excess spending.

Karen Coderre (pictured at left), director, pharmacy clinical management and quality for Blue Cross NC, and Libby Johnson (pictured at right), senior vice president, client success for Artemetrx, showcased Blue Cross NC’s success using Prime’s Specialty Monitor tool.

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has maximized use of Specialty Monitor to achieve notable results. To share its success story with industry peers, Blue Cross NC and Artemetrx jointly presented “Radical Transparency: See What Can Happen When Integrated Data Is Leveraged to Address High-Cost Conditions, Control Drug Spend and Promote a Better Member Experience” at the Pharmacy Benefit Management Institute (PBMI) National Conference in early March. Karen Coderre, director, pharmacy clinical management and quality for Blue Cross NC, and Libby Johnson, senior vice president, client success for Artemetrx, showcased Blue Cross NC’s success using Prime’s Specialty Monitor tool.

Combined with guidance from a Prime pharmacist dedicated to analyzing Blue Cross NC’s specialty claims data, Specialty Monitor has identified many provider and member intervention opportunities, including steering members to the right dose of a medication and reducing instances of duplicate therapy. For example, one member was using two high-cost therapies for the same condition, prescribed by different providers. Blue Cross NC used this knowledge to coordinate with providers, eliminating duplicate drugs, improving patient safety and ultimately creating a $40,000 potential savings opportunity. Blue Cross NC interventions uncovered via Specialty Monitor are on track to deliver an estimated $5 million in future savings.

“One of the ways Blue Cross NC is transforming health care is through our Blue Premier value-based care program,” Coderre said. “In working with our Blue Premier provider partners, it’s important to bring them actionable pharmacy data. As we move forward in this partnership, Prime’s dedicated pharmacist identified the need to have proactive medical edits, and we are making many changes to incorporate these changes into our value-based care. We’re grateful to Prime for providing rich data through Specialty Monitor in a way that’s much easier to act upon than conventional data processes.”

Prime used Specialty Monitor to help Blue Cross NC identify additional ways to curb wasteful drug use and spend, including cutting out duplicate hormone therapy claims during a short timeframe and helping ensure a patient received the right form of a cancer drug (in a tablet form instead of a capsule). Interventions in both categories have the potential to save tens of thousands of dollars each month.

Johnson said, “While one intervention resulted in $90,000 in annual savings for just one member, the savings are exponential because Blue Cross NC can identify similar members and duplicate that savings across all members and populations.”

Coderre also highlighted the ability to use Specialty Monitor to look at medical and pharmacy data from various vantage points and angles – such as by drug, by category, by member, by provider and inclusive of additional factors like diagnosis. Coderre said, “This tool allows us to show providers how they can take action, like moving a member’s treatment from a more costly setting to a clinic or their home, ultimately saving on total health care spending while improving the patient experience.”