Comprehensive clinical solutions help connect care and get people the medicine they need when they need it. Prime delivers integration to support adherence and appropriate medication use, help mitigate gaps in care and engage members and prescribers. With these solutions, we help our customers improve safety, decrease waste and connect the entire care journey.


Better medication management decisions

GuidedHealth identifies opportunities to improve medication safety and address gaps in care, unsafe use and potential misuse. Taking a 360-degree view of a member’s clinical profile, GuidedHealth delivers actionable clinical intelligence to providers, members and plans through a personalized, omnichannel approach.



Integration promotes safer opioid use

For one large employer group, integrated data from Prime pharmacy claims helped decrease high opioid use for 1 in 3 members — and even helped prevent one potential opioid overdose.3


Better adherence potential after a benefit change

Transition Fill offers a temporary fill or refill of a non-formulary drug within the first 90 days of a benefit change. This solution helps improve the member experience and promotes better medication adherence.


Safety and support for members

Prime uses a thorough approach to help manage appropriate use of controlled substances. This program improves oversight of people who are at risk for substance use disorder, supports continued research and enhances pharmacy and provider monitoring. It also provides education for members about the risks of controlled substances.


Increased efficiency and a better experience

This product proactively notifies prescribers and members of expiring drug approvals, helping people get the medicine they need with no gaps in care. PA Notify helps improve member satisfaction, reduce appeals and grievances and enhance efficiency for providers.


Improved experience, significant savings potential

SmartRenew uses past data to proactively renew drug approvals (like prior authorizations and formulary and quantity limit exceptions) before they expire, helping avoid unnecessary gaps in treatment and improving the member experience. This product also provides savings opportunities by reducing clinical review costs.

1 Prime Therapeutics internal data, 2022; savings specific to health plan, not employer group

2 Across all three programs: Opioids and Controlled Substances, Medication Therapy Management (MTM) and Smart Adherence

3 Prime analysis, 2021

4 Based on a case study of two plan groups; rejected fills were originally 20%