Get help building your medical pharmacy strategy 

As pioneers in managing drugs on the medical benefit, we offer next-generation medical pharmacy solutions and market-leading specialty capabilities built to mitigate rising specialty costs while helping your members achieve better outcomes.

Innovative medical pharmacy solutions that drive savings 

At Prime Therapeutics (Prime), we develop customized solutions and targeted, innovative programs to meet your members’ unique needs. With support from clinicians and our Expert Clinical Network of physician key opinion leaders (KOLs), we help you ensure your members receive the right treatment at the right time for their high-cost, physician administered drugs. In addition, we optimize medical formulary strategies to maximize net cost savings. 

We manage medical benefit drugs with the same rigor as pharmacy benefit drugs, tapping into a suite of solutions that help drive significant savings while addressing the latest challenges in our industry. We offer flexible solutions that operate outside of the traditional payer-pharmacy benefit manager (PBM) relationship. Health plans can plug into our extensive clinical expertise and experience by delegating medical drug management services while retaining a separate PBM. 

16M

We manage 16M lives across our medical pharmacy solutions.

$930M

We’ve helped our partners realize $930M in medical drug savings.

99%

Prime is proud of our industry-leading 99% provider satisfaction rate.

7%

Our medical pharmacy solutions help decrease appeals and drive a denial rate of less than 7%.

Prior authorization (PA)

Get more out of standard utilization management programs. We help ensure complex and high-cost drugs are prescribed according to evidence-based policies, while recommending optimized dosing and eliminating waste — helping you maintain high-quality care.

Post-service claim edits

With a technology platform that complements our robust PA process, we promote correct payment of medical benefit drugs by aligning dose and frequency information for each claim and its related authorization, a process that does not disrupt the provider's workflow.

Provider network strategy

We help promote lower-cost, equally effective agents through maximum allowable cost (MAC) and least cost alternative (LCA) pricing strategies, while ensuring equitable reimbursement for physician administered drugs.

Site of service

Help your members get the injectable medicine they need, when and where they need it, at an affordable cost. We guide medical injectable drug administration to the lowest-cost and most clinically appropriate sites.
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