30 Prime-supported Medicare contracts earn quality bonuses

Prime Therapeutics (Prime) helped 30 of its Medicare Advantage Prescription Drug (MAPD) contracts, representing 92% of MAPD membership, receive a quality bonus payment for earning four stars or more in the ratings released by the Centers for Medicare and Medicaid Services (CMS). This includes five contracts that achieved a 5-Star overall rating, and 10 new contracts that earned a quality bonus payment compared to last year.

Stars and total drug management

As a pharmacy benefit manager, Prime influences many of the Star rating measures across:

• Operations
• Customer experience
• Medication adherence and clinical management

Prime helped improve our plans’ ratings for Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, which are highly weighted measures in determining overall ratings. These member surveys include an overall rating of the drug plan, and how easy it is for the member to get needed prescriptions.

“These ratings show that Prime is contributing to improving the quality of health care, while at the same time making health care more affordable and accessible to Medicare members,” says Kim Kishel-Geiger, senior director, quality management. “Each year favorable ratings become more difficult to achieve because the bar is continually raised, so we must continue to be innovative.”