^{Jackie Jacobson is a senior director of the Government Programs Center of Excellence at Prime Therapeutics.}

The health care landscape is seemingly more complex with every passing day. Perhaps more so for our clients and members served by government programs, particularly Medicare.  

In recent years, we have seen the introduction of the Inflation Reduction Act (IRA), a new administration and mounting financial pressures on the pharmacy industry. But in many ways, Prime Therapeutics (Prime) continues to sharpen its focus to be able to deliver improved access and costs to life-saving medications.  

We may be halfway through 2025, but the Medicare Center of Excellence at Prime is finishing Medicare bids for 2026. During the bid process, we work with clients to estimate the revenue needed to provide beneficiaries with competitively positioned and strategically aligned Medicare prescription drug benefits and additional Prime-supported supplemental benefits. We also consider formulary strategy and benefit design, and more. 

This means that we at Prime are focused on other factors to deliver a better experience for both plans and patients, including our Predictive Model product and Enrollment Capabilities. 

Prime's Predictive Model is a standalone product that helps plans forecast future individual member pharmacy expenditures. This forecast provides data that helps plans identify members who are likely to be a drug cost rapid riser, or more commonly, someone whose drug cost may double and be above $2,000 over a 365-day period. This allows our clients to better predict their costs in the bid development process and engage members to support their health care journey. 

Prime’s Enrollment Capabilities include providing a non-broker enrollment call center to support prospective members, premium billing, financial reconciliation, welcome kits/ID cards and other member materials. Also, we can integrate with plans’ Part B claims adjudication platforms and provide eligibility files for external distribution. 

Other initiatives, like our Medicare Plan Finder strategy — the Medicare marketplace where members shop and enroll in a plan — position our clients to best compete in the market. We also are leading the way in emerging trends, like Food as Medicine, by offering a new product to support clients who want to offer a supplemental benefit that gets upstream to help keep members healthy. 

This is all part of our long-term focus to get ahead of the curve with a range of go-to-market capabilities that help plans engage brokers and members to understand the true value of Prime’s programs.  

Through our Save, Simplify, Support™ approach, Prime can help plans provide an easier and more transparent experience that can lead to better member health outcomes. For example, Prime also offers Member Experience Analysis & Consulting, a first-of-its kind report that consolidates and analyzes key drug benefit usage data from across Prime’s ecosystem and includes recommendations to prevent member disruption and improve their experience. 

Additionally, Prime provides end-to-end consultation for clients through four key elements of Part D plan portfolio bid formulation: benefit design, network selection, formulary selection and trend development. Client considerations across these elements are significantly impacted by the continued roll-out of IRA provisions as well as additional market and regulatory changes. Prime increased the scope of its market and client-specific analytics this year to address these challenges. 

In other words, we are focused on supporting Prime's new government programs products and services that deliver not only greater affordability but also improved health outcomes.