HELPING TO LOWER DRUG COSTS
One of the best ways to drive to the lowest total cost of care is effective formularies, and a well-managed formulary starts with proactive, comprehensive pipeline management. Prime builds on this strong foundation by focusing on providing quality, highly configurable options for formulary management.
A powerful tool for integrated drug management
Our NetResults formulary includes a balanced mix of medications while omitting drugs that are unnecessary or more costly compared to other available therapies (e.g., brands with effective generic equivalents). Simply put, we deliver flexible options, allowing you to choose the solution that works best for your business and employees.
NETRESULTS CASE STUDY
Big savings with no member disruption
NetResults can have a dramatic effect on an employer group’s bottom line. One 9,000-employee group in the energy solutions and natural gas industry was using an unmanaged approach to formulary and utilization management, and they were concerned about employee disruption if they implemented a new approach. However, the rising cost of drugs was becoming too much to bear. Prime recommended a managed formulary with new utilization management programs, and the employer saw clear results, including $17 PMPM savings — with no negative impact on the employee experience.1
POINT OF SALE REBATES
Rebates direct to members at their local pharmacy
This product helps reduce member drug costs right when they’re buying their medication by subtracting a portion of any applicable manufacturer rebate before determining the member’s out-of-pocket cost. This provides extra savings to those with high deductibles and coinsurance.
REAL-TIME BENEFIT CHECK
Support in making better prescription decisions
Using the electronic medical record (EMR) at the point of prescribing, this product supplies member-specific benefit information to prescribers in real time so both the prescriber and member can make the right prescription decisions. Benefit information includes drug coverage and pricing as well as information on alternative drugs that are equally effective but may cost less than the originally selected drug.
RX SAVINGS SOLUTIONS CORE SOLUTION
Greater price awareness and engagement
This web-based software fully integrates with benefit design to analyze claims as they come in, providing greater transparency and high-touch member engagement. Members see the lowest available price, helping them become better consumers and resulting in savings across the board.
Integrated data to optimize drug use
Prime applies machine learning across integrated end-to-end data from the pharmacy benefit (e.g., oral tablets) and medical benefit (e.g., IV drug infusions) to help identify ways to optimize drug therapies and save costs. These opportunities include drug oversupply, duplicate and low-cost yet equally effective therapies, dosing forms and regimens, and sites of care. Specialized pharmacists then reach out to providers with recommendations.
1 Retrospective savings report on PMPM cost avoidance/savings in 2022
2 Based on completed contact prescribers across RxSS’ book of business during 2022 fiscal year