Prime Therapeutics (Prime) has developed innovative outreach programs which we offer in partnership with our Blue Cross and Blue Shield Plan owners and clients (Blue). These programs use pharmacy claims to identify cost-saving opportunities.
Expert pharmacists really make a difference in helping members get the medicine they need. And this plays an important role in cost control. Connecting with pharmacists can save $4.73 for every dollar invested.1
Pharmacists and Prime members
Prime’s medication therapy management (MTM) programs rely on pharmacists to engage with members wherever they are. Pharmacists understand the health care system. They know how drugs may differ with regard to indications, efficacy, safety and adherence. They have earned the public trust as a source of health information and advice.
A proactive part of the big picture
Pharmacists help members with their medication therapy. They can identify, resolve and prevent drug-related problems. This is particularly important for those members suffering from chronic conditions that have complex medication therapy.
Pharmacists play a critical role to support products offered by Prime. They can intervene when an adherence issue or gap in care is identified. Pharmacists at Prime can help members follow their treatment plans and achieve better health outcomes.
Connecting with pharmacists can save $4.73 in overall health care costs for every dollar invested.1
Case study: improving health outcomes2
MTM pharmacists perform yearly comprehensive medication reviews (CMR). That’s when a pharmacist walks through a member’s medications to make sure they are working correctly. During a routine CMR, one member reported to the pharmacist that he felt tired all the time.
- Solution: the MTM pharmacist noticed that a member was taking two duplicate beta blockers — the common side effects of beta blockers are fatigue and an increased risk of falling.
- Result: the pharmacist’s catch may have prevented future health problems for the member and spending a lot of money on doctor visits.
Case study: improving outcomes and supporting Star measures2
During a yearly CMR, a member told an MTM pharmacist that her blood pressure had been high lately. The pharmacist noticed the member was not filling her trandolapril (a blood pressure medication) as often as she should and asked the member to check the bottle. The member noticed that the directions said to take one tablet twice daily. She had only been taking one tablet once daily and had not checked the new directions on her bottle after her last appointment. The pharmacist also asked the member about her pravastatin (for cholesterol) that had not been refilled recently. The member realized that she had forgotten to pick up her medicine in January of 2015 and had not refilled it since.
- Solution: The member agreed to start taking her blood pressure medication as directed and check her blood pressure regularly. The member promised to fill the statin prescription that day and start taking it as directed.
- Result: The pharmacist’s catches may prevent future health problems for the member. This call contributes to these 2016 CMS measures: 1) CMR completion rate for MTM and 2) Adherence for hypertension and hyperlipemia.
Case study: Gap in care2
A pharmacist received a targeted intervention program (TIP®) or clinical alert about a critical gap in a cholesterol-lowering therapy for a member with diabetes.
- Solution: The pharmacist urged the member’s doctor to prescribe additional medicine. The doctor added this prescription for the member.
- Result: Her action ultimately decreased the member’s risk of a future cardiovascular complication.
At Prime, pharmacists are often the point of engagement with members and their doctors.
By strengthening the connection among pharmacists, doctors and members, Prime helps reduce wasteful spending and more importantly helps strengthen member care.
Behind all of Prime’s products and services are people helping people. Exceptional, dedicated people helping people.
- Return on investment data provided by Outcomes Incorporated.
- Prime MTM case studies.