Capital BlueCross taps Prime Therapeutics for PBM

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Harrisburg, Pa.-based Capital BlueCross is forming a partnership with pharmacy benefit manager Prime Therapeutics.

Capital BlueCross and Prime Therapeutics, based in Eagan, Minn., entered into a three-year, full-service agreement effective at the beginning of the year that covers commercial and individual market members, as well as members enrolled in Capital BlueCross' Medicare and Children's Health Insurance Program.

The agreement expands the relationship begun last year, when Prime began providing specialty drug management services to Capital BlueCross' commercial and Medicare members.

Under the new agreement, Prime will provide customized drug therapy based on specific biologic needs. It will also integrate medical and pharmacy coverage with advanced disease management programs, in addition to managing Capital BlueCross’s supply chain.

"We are in an era of drug revolution," says Peter Mikhail, vice president of pharmacy operations for Capital BlueCross. "This is an exciting time — as science is discovering cures to devastating diseases, we will see the dramatic, life-saving results. Within that landscape, it is increasingly important to provide access to the many medicines helping our members and their families, to promote safe utilization, and to manage costs.” Prime will be “a differentiating factor” in helping Capital BlueCross achieve its goals, he says.

Prime will use analytics on its more than 28 million members nationwide to predict trends, build formularies and to deploy standards. With the data generated from the nearly 400 million healthcare claims annually, Prime partners with the advanced analytic capabilities of Geneia's Theon platform, to yield an integrated approach to managing the total cost of care.

“The insights derived from Prime and Geneia help identify and act on fraud, waste and abuse across pharmacies, providers and patients, resulting in millions of dollars in savings,” executives at Capital BlueCross say.

The new collaboration will also give Capital BlueCross members access to an extensive network and delivery options, 24/7 member services, advanced clinical resources to help members manage medical conditions, and "My Rx Guide," a one-on-one medication consultation for designated members with complex needs, the companies say.

Capital BlueCross, serving central Pennsylvania, is currently the only health plan in Pennsylvania to offer the benefits of Prime Therapeutics to its members. "We are delighted that Capital BlueCross has chosen Prime as its full-service pharmacy benefit manager," says Ken Paulus, president and CEO at Prime. "As health plans, employer groups, and members continue to be challenged by unsustainable drug costs, we are committed to finding innovative solutions to help make medicines more affordable. Year over year, we've delivered among the lowest drug cost trends, evidence of our effectiveness in driving lower costs and improving health outcomes."

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