EAGAN, Minn. – Prime Therapeutics/Magellan Rx Management (Prime/Magellan Rx) today revealed its new specialty pharmacy care solution, Advocate+^™. Building on the previously announced Advocate+ Pharmacy Match solution aligning members with the best-fit pharmacy, the company continues to expand its Advocate+ suite to offer additional member-centric capabilities, providing support for navigating utilization management edits, financial assistance, and social determinants of health (SDOH) through scalable, technology-enabled processes to help ensure the best member experience.

This latest transformative solution to enhance member experience offers a novel holistic program that guides members through their personalized specialty pharmacy journey beginning the moment a prescription is written. Member advocates intervene upstream, helping pave a shorter path to treatment with advance prior authorization (PA) support and proactive identification of financial assistance opportunities. Through its Advocate+ program, Prime/Magellan Rx helps members reduce overall health care costs and enhance access to necessary medications and care.

A 2023 Kaiser Family Foundation poll showed nearly three in 10 (28%) Americans struggle to afford the medications they need.  Further, according to the Centers for Disease Control and Prevention (CDC), 9 million adults (8.2%) in the U.S. are not taking their prescription drugs as prescribed, due to the high cost of medications. Research found that some people compensate by not filling prescriptions, rationing medications or even going without basic needs like gas or groceries.

“Advocate+ focuses on providing care that addresses the unique needs of members with complex conditions, while simplifying the steps that may be required to begin treatment,” said Nathan Downhour, senior vice president of pharmacy and care solutions for Prime/MagellanRx. “With this tailored approach, we aim to ensure that every member can receive the personalized care they need with less effort and cost. Advocate+ leverages advanced technology that will benefit people in real time – the moment they may be deciding whether they can afford rent or pay for their medication. This enhancement builds upon our Advocate+ Pharmacy Match solution to further increase access to affordable medication and help members navigate the specialty care journey.”

Advocating for members to provide the specialty care they need

Advocate+ proactively identifies financial assistance options for a member – such as manufacturer copay cards/coupons, foundations, and SDOH assistance programs – using key prerequisite information like insurance type and diagnosis to match with relevant opportunities. Beyond the prescription, SDOH programs provide a range of non-medical assistance types such as transportation, rent or food subsidies, or help with utility bills.

To better deliver elevated member care management, Advocate+ leverages TailorMed’s comprehensive technology solution. TailorMed supports the full assistance program lifecycle, including eligibility, enrollment and claims management. Its best-in-class platform uses a data-driven process to flag financially at-risk members and identify relevant funding opportunities based on their insurance, clinical and demographic data. The platform draws on a database of over 7,000 assistance programs, addressing medication needs across diagnoses as well as SDOH. It then streamlines the enrollment process, offering up to a 60% time savings per application through its unique Express Enroll automation with manufacturer assistance programs, reducing existing manual, time-consuming processes.

“It’s gratifying to see Prime/Magellan Rx at the forefront of tackling affordability,” said Srulik Dvorsky, co-founder and CEO of TailorMed. “Prime/Magellan Rx and TailorMed share a mutual goal of ensuring each member is presented with every financial opportunity to decrease their out-of-pocket cost, which will ultimately improve adherence and health outcomes.”

Speed to therapy and other holistic services

In addition to the financial strain, some members might hesitate to fill medications that require pre-approval. Advocate+ employs a streamlined PA feature, minimizing the waiting period for medication approvals. And Advocate+ Care Specialists provide ongoing support and education for members treated with complex therapies prescribed for conditions including cancer and multiple sclerosis.

Advocate+ will be activated with select clients beginning Jan. 1, 2025. Follow Prime/Magellan Rx as it continues to emerge as the comprehensive specialty solutions partner of choice.