OPTIMIZING DRUG ACCESS
Channel optimization means members get their medicine the way they want, at the lowest available cost — and that our customers choose solutions that best meet their needs. That’s why Prime offers a portfolio of flexible solutions to help provide the best pharmacy options for members.
FWA monitoring across pharmacies, prescribers and members
Prime’s fraud, waste and abuse (FWA) solutions set the standard for detecting and preventing fraud. Many PBMs offer pharmacy fraud products, but Prime can extend fraud protection to cover member and prescriber fraud. Our FWA offering encompasses all in-network pharmacy types, including retail, mail and specialty.
Smart tech to uncover cost avoidance opportunities
Prime’s Advanced Fraud, Waste and Abuse (FWA) platform integrates pharmacy and medical claims data, then applies AI technology and machine learning capabilities to detect FWA across the health system, helping to avoid unnecessary costs. Recognized by Fast Company for this first-of-its-kind initiative leveraging AI technology to fight FWA, Prime’s platform helped clients save more than $206 million in FWA in 2022 alone.¹
FLEXIBLE COMMERCIAL NETWORKS
Built to provide access, savings and choice
Prime’s pharmacy networks allow choice in level of management to help deliver cost savings and maintain member satisfaction. We work with our customers to build preferred provider networks and incorporate enhancements members need, helping to ensure the right pharmacies are included.
Maintenance medications made easier
With 90DayMyWay, members can receive a 90-day supply of their long-term medicines through a retail pharmacy or mail delivery. This flexibility promotes fewer refills per year, increasing medication adherence and lowering costs.
MEDSYOURWAY® – RETAIL
The best available price at local pharmacies
This solution automatically compares several discount drug prices to the plan benefit price behind the scenes. When a member picks up their medicine, all they need to do is show their insurance card when they fill a prescription to get the lowest available price. They can also access discounts on non-covered and prescribed over-the-counter (OTC) medications.3
HOME DELIVERY SERVICES
Flexible solutions to fit member needs
Prime provides flexible home delivery options, offering 90-day fills of long-term medicines delivered right to members’ doors. We take this omnichannel approach so members have the access, tools and support they need to get their meds in the ways that work best for them.
¹ Prime Therapeutics internal data, 2020.
2 Prime Therapeutics internal data, 2022; total number of contracted pharmacies depends on network used.
3 MedsYourWay – Retail product compares several discount card prices, on a list of qualifying drugs, to offer members the lowest available price for medications.
4 Milliman analysis against Prime’s commercial client claims from Oct. 2020–Mar. 2021 and discount drug card fee schedule as of Q1 2021.
5 Amazon Pharmacy does not dispense Schedule II controlled substance drugs.