One year on, the Prime/BCBSRI alliance is producing results.
Last January, BCBSRI transitioned to a new PBM, Prime Therapeutics. Since that time, Prime has proven its value many times over, and consistently demonstrates its commitment to closely aligning with not just BCBSRI, but also 22 other Blue plans with 27 million members nationwide. This month, Prime issued its 2017 drug trend report.
The report states that on average its clients saw overall expenditure reductions (per member per month) across all lines of business—commercial, Medicaid, and Medicare—compared to 2016. This represents the second consecutive year of outstanding trend results.
Prime’s numerous management tools were fundamental in helping to lower commercial drug trend to -0.2 percent, Medicare Part D to -0.8 percent, and Medicaid to -5.4 percent. Additionally, corresponding annual savings delivered to clients in 2017 exceeded $3 billion across all three lines of business.*
“Our outstanding 2017 drug trend results are hard won, especially as we continue to see ongoing and significant price increases for medicines in some of the most expensive disease categories,” said Jim DuCharme, Prime’s president and CEO. “These outcomes require many dedicated employees working tirelessly on behalf of our clients and their members to deliver optimal care and prescription drugs at the lowest net cost. Our close alignment with 22 Blue plan clients—18 of whom are owners—allows us to see the complete pharmacy and medical drug picture to help us drive total cost of care outcomes.”
Beth Hebert-Silvia, Managing Director of Pharmacy at BCBSRI, likes Blue’s alignment with Prime: “Their wealth of resources, tools, and implementation experience developing pharmacy programs for other Blues assured us that they were the perfect partner for us. We’re continually impressed by their ability to adjust to our needs, and by how innovative and collaborative they’ve been.”
BCBSRI’s integration with Prime Therapeutics reveals further good news:
- Collaboration allows for a broader view of each patient’s health, and helps to identify candidates for case and disease management programs
- A dedicated local team designs a pharmacy solution to best support your clients’ needs
* Prime Therapeutics “Focus on Trends” Spring 2018
Prime Therapeutics LLC is an independent pharmacy benefit management company, contracted by Blue Cross & Blue Shield of Rhode Island (BCBSRI) to provide pharmacy benefit management and home delivery pharmacy services.
Integration
The latest numbers are in from our pharmacy experts and the news is good.
Since 2014, Blue Cross & Blue Shield of Rhode Island has created $23 million in total healthcare savings with its patient-centered pharmacy program.**
We knew that using a single carrier for medical and pharmacy saved time. We now know that it saves serious money. New internal data from 2016 for employer groups has found that integrated models result in lower medical costs for members, including 8% fewer hospital admissions, 5% fewer specialty visits, and 14% lower medical costs for diabetes. ***
More importantly, medical and pharmacy benefit integration improves the coordination of care for members. There is easier access to a more comprehensive understanding of a patient’s health journey.
Optimizing pharmacy care can lead to decreased medical spend for members with chronic conditions as well. It’s also an effective way to control healthcare costs. Groups with integrated benefits also see savings on members with conditions that rely on medications for treatment. This is news you can take to clients with confidence.
** Based on direct costs of reduced or avoided drug costs annualized and on indirect costs supported by an actuarial model estimating the cost of a medical intervention.
*** Study commissioned by the Blue Cross Blue Shield Association, 2016