Leveraging integrated data to help identify high-impact savings opportunities
Only 1% of members account for 50% of specialty drug spend. Finding members with complex conditions and determining drug therapy intervention opportunities helps lower costs for health plans and members.
HighTouchRx®
We combine integrated data, actionable insights and pharmacist outreach in one innovative product
HighTouchRx uses exclusive clinical predictive modeling applied to medical and pharmacy data, making it easy to quickly locate high-cost members and offer interventions.
Integrates pharmacy and medical data
HighTouchRx identifies 1,000+ medical drugs and pharmacy savings opportunities.
Offers specialized outreach
Clinical pharmacists partner with health plans to provide high-touch outreach.
Improves care
HighTouchRx promotes member safety and savings opportunities.
Quickly locate high-cost members and offer interventions
WatchCase study
Optimized vial medical claims
Analytic intel + insights
HighTouchRx identified 576 non-optimized vial medical claims across 30 drugs for one Blue plan.
Outreach
The Prime team provided the plan with information on the non-optimized claims, along with a medical policy edit process recommendation.
Optimization
The plan implemented proactive medical edits to prevent payment for non-optimized drug vials in accordance with their provider policy.
Significant savings from capsules
Analytic intel + insights
HighTouchRX identifies potential savings due to a cost difference between Imbruvica® tablets and capsules.
Outreach
Prime contacted prescriber to recommend a change to capsules and an update to the prior authorization to allow for this coverage.
Outcome
The health plan realized substantial savings – with zero out-of-pocket impact to the member.
Fewer injections, better experience, lower costs
Analytic intel + insights
HighTouchRx determined that a member was using two strengths of Trulicity® to control their diabetes.
Outreach
Prime contacted the member’s provided to recommend a prescription adjustment after the release of a new high-strength formula.
Outcome
The provider adjusted the prescription, meaning fewer injections for the members and savings for the health plan and member.
Plan and member savings from generics
Analytic intel + insights
HighTouchRx identifies a member who was taking a name brand medication, Sabril®, when a cost-saving, clinically effective generic was available.
Outreach
Prime reached out to the prescriber to recommend a change to the generic based on availability and cost.
Outcome
Both the member and health plan realized significant savings thanks to a change to the lower-cost generic.
Better care at a lower cost
Analytic intel + insights
HighTouchRx identifies a member using a high number of expensive, low-strength Cabometyx tabs.
Outreach
The Prime pharmacist and provided agreed to consolidate doses, then contacted the member and pharmacy.
Outcome
The member’s pill burden was reduced resulting in improved care and reduces costs.
Recognition
HighTouchRx pilots awarded for cost containment
The Pharmacy Benefit Management Institute (PBMI) awarded Prime Therapeutics’ HighTouchRx managed care pilots with a 2021 Excellence Award in the category of cost containment.
NEWS
Press releases
January 11, 2022
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…
Stories
September 15, 2021
Prime’s High-Value Pharmacist Managed Care pilots win PBMI Excellence Award
The Pharmacy Benefit Management Institute (PBMI) honored Prime Therapeutics’ High-Value Pharmacist Managed Care…
Press releases
April 15, 2020
Managed care pharmacist program sees 9:1 return on investment
EAGAN, Minn. – A program by pharmacy benefit manager (PBM) Prime Therapeutics LLC…