Transforming specialty care for better outcomes and affordability

"We want [the patient] to get the right drug at the right time. We even want to make sure they get the right diagnosis and then carry that all the way through to the site of care, getting them to be adherent. ... The solution is really to align the entire economic model … shifting to an alignment around the outcome tied to the patient." -George Van Antwerp, Senior Vice President of Product Innovation and Strategic Planning at Prime

"Innovation is driving better outcomes, but it's also driving a lot more complexity, higher costs and a need to integrate some of those things, not just medical benefits and not just pharmacy benefits. … At Prime, you've heard that we think one of the most important differentiators is our ability to bring medical and pharmacy benefits together. … I think [the future of oncology] will be defined by our ability to actually deliver that innovation in a way that meaningfully expands access, which we all want, improve outcomes and then remain affordable for the patients we serve." -Abby Kim, PharmD, BCOP, Senior Director, Clinical Strategy and Specialty Solutions at Prime

Breaking down barriers between medical and pharmacy care

Managing specialty care effectively requires looking beyond individual pharmacy claims to understand the patient's full care journey.

Prime President and CEO Mostafa Kamal emphasizes that patients do not experience their conditions through separate medical and pharmacy benefits, and their care should not be managed that way. Because Prime's differentiated model is not tied to fulfillment, it prioritizes the most clinically appropriate and cost-effective care options rather than steering patients toward owned pharmacy assets.

Prime's IntegratedRx solution demonstrates this approach by giving patients with complex conditions, including cancer and cystic fibrosis, the option to fill medications within their care clinic. This helps keep pharmacists and providers connected to better coordinate care, reduce treatment delays and improve the patient experience.

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By aligning incentives around patient value, Prime helps employers and health plans develop specialty drug management strategies that improve care coordination, simplify the patient experience and promote affordability - helping patients access the care they need and stay healthy.

Prime offers capabilities designed to support different client and member needs, including:

• IntegratedRx helps improve care coordination for complex conditions
• HighTouchRx^® identifies cost-savings opportunities for medications, including specialty
• Advocate+^® breaks down barriers to care by simplifying the experience, offering education and finding a best-fit pharmacy for patients

See how Prime is rethinking specialty pharmacy

^{Products, services and capabilities vary by client and market.}