Prime’s cost transparency pilots

This week, Prime’s leadership and its 23 clients gather in Minneapolis for an annual summit. Each year, Prime brings its health plan client partners together to share innovative clinical solutions and total drug management strategies, while providing a forum for sharing best practices. Innovation around cost transparency is one of the many featured items on this year’s agenda.

Client goals and early insights related to co-innovated cost transparency pilots will be presented during the summit. Greater cost transparency is growing in importance as prescription drug list prices continue to rise dramatically. According to a recent Scripps Research study, the median price of 49 top-selling brand name drugs rose 76 percent over six years. The study, which used proprietary data from the Blue Cross Blue Shield Association (BCBSA), showed prices of some popular drugs – for conditions like diabetes, high cholesterol and rheumatoid arthritis – more than doubled from 2012 to 2017. A lack of consumer and physician transparency on actual drug prices enables manufacturer price increases and befuddles health care consumers.

Consumers and payers need effective strategies to manage the high cost of drugs. As a total drug management company, Prime identifies the best opportunities to achieve client and member savings while balancing optimal outcomes for their members. To that end, Prime is piloting or planning to pilot multiple programs with various vendors to improve the prescription drug experience – for the member, provider and pharmacist. Using Prime’s superior partnership model, Prime and Blue plan clients are collaborating to test and understand – and eventually scale – the type and/or combination of cost transparency solutions found to be most effective.

Prime’s innovations keep the member top of mind. For members who are frustrated with a lack of drug pricing transparency, Prime is currently testing several cost transparency tools designed to take the guesswork out of filling prescriptions. Prime’s pilots aim to:

1. Empower members with drug and cost information before their prescription fill,
2. Eliminate cost surprises when members fill prescriptions while providing opportunities for greater savings,
3. Provide members and physicians with cost and drug benefit information for more informed, in-the-moment decision making while at the doctor’s office, and
4. Streamline the prescription-filling process for both the member and pharmacist by suggesting equally effective drug therapies that do not require prior authorization or step therapy.

Member ease

One transparency tool Prime’s testing is an easy-to-use mobile app technology. The app proactively identifies cost savings opportunities based on prior pharmacy claims history, issues direct-to-member communication alerting them to each savings opportunity, and empowers members to select lower cost options that allow us to take immediate action to save money and avoid frustration.

Prescriber ease

Like consumers, providers who prescribe medicines also feel the frustration of unknown drug prices and lack transparency to their patients’ insurance benefits. To increase provider efficiency and improve the member experience, Prime is piloting several vendor tools that work with a provider’s existing electronic medical records (EMR) system to show alternative drug options that are equally effective, but carry a lower member and total cost than the originally selected drug. One tool Prime is testing shows a member’s cost share and any additional steps needed for filling the original or alternative drug, enabling providers to discuss options with members and make informed decisions together at the point of care. This technology helps providers select the most cost-effective drug the first time and helps members better manage their drug spend. Providing everyone in the delivery system with access to real-time prescription cost and benefit information can not only reduce unnecessary cost surprises when filling a prescription, but it can also drive medication adherence. It can also decrease costs associated with authorization reviews, which in turn can help avoid unnecessary medical treatment and control overall health care costs.

Coming soon

Pharmacists on the frontline of health care delivery also need tools to help people get the best medication at the best cost. Next, Prime plans to test a mobile app that identifies alternative drugs that may be less expensive than a prescribed drug.

“We know there’s no silver bullet to simplify the current, complex health care system,” said Laura Terry, vice president, marketing and communications at Prime. “As a total drug management company focused on innovation to help heath care work better, we are always striving to deliver new ways to better manage drug costs to our clients and the market – using multiple tools, with multiple clients and multiple points in the delivery system to see what’s most effective. These innovative client collaborations are living proof of the power of our alignment with Blue plans.”

Prime will evaluate results from these transformative pilots to optimize future client offerings. In 2019 and beyond, Prime will continue to build solutions and partner with clients to bring the best possible tools to the market to ensure superior client and member experience as well as cost savings.