Capital BlueCross Advances Its Precision Drug Access & Cost Reduction Initiatives with New Pharmacy Benefit Manager

HARRISBURG, Pa., Jan. 27, 2020 /PRNewswire/ -- As drug costs rise and new therapies bring both life-saving promise and unprecedented expense, Capital BlueCross remains committed to providing its members with the drugs they need at a price they can afford, while also driving innovation within the drug industry to facilitate better health outcomes.

Starting in 2020, Capital BlueCross is working with a new pharmacy benefit manager, Prime Therapeutics, LLC (Prime), to help advance these goals through collaboration on:

    --  Precision drug access - Healthcare is no longer only preventive or
        diagnostic. Doctors can now customize care based on patients' specific
        biologic needs. Capital BlueCross aims to ensure its members have access
        to the most appropriate drug therapies in order to achieve the best and
        most efficient clinical outcomes.
    --  Integrated management of health outcomes - By integrating medical and
        pharmacy coverage with advanced disease management programs, employers
        can generate significant savings by empowering healthier, informed
        employees to incur fewer hospitalizations, reduce emergency room visits,
        and better adhere to their medication plans.
    --  Supply chain management - Prime actively manages the pharmaceutical
        distribution process in order to drive safe, rapid, and cost-effective
        drug delivery. Supply chain management can now be influenced with the
        purchasing power of more than 100 million individuals nationwide.
    --  Improving health by using actionable analytics - With more than 28
        million members nationwide generating nearly 400 million healthcare
        claims annually, Prime offers a powerful analytics engine to identify
        and predict trends, build award-winning formularies, and deploy
        standards to enhance safety and access to new or evolving therapies.
        This analytics engine, coupled with the advanced analytic capabilities
        of Geneia's Theon platform, will yield an integrated approach to
        managing the total cost of care.
    --  Striving to eliminate fraud, waste, and abuse - 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.
    --  Enhanced member experience - Healthcare consumers increasingly want
        choice and convenience. With this collaboration, members have 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.

"We are in an era of drug revolution," explained 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.

"With some of the best scientists in the industry, association with world-renowned research institutions, innovation and speed to market, we know Prime Therapeutics will prove to be a differentiating factor in helping us achieve our goals."

Capital BlueCross will be 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," said 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."

Capital BlueCross and Prime Therapeutics entered into a three-year, full-service agreement effective Jan. 1 that covers commercial and individual market members, as well as members enrolled in Capital BlueCross' Medicare and Children's Health Insurance Program (CHIP). It expands the relationship between the two companies, as Prime Therapeutics began providing specialty drug management services to Capital BlueCross' commercial and Medicare members last year.

About Capital BlueCross
For more than 80 years, Capital BlueCross has served Central Pennsylvania and the Lehigh Valley by offering health insurance products, services and technology solutions that provide peace of mind to consumers and promote health and wellness for our members. The company delivers innovative solutions through a family of diversified businesses to create healthier lives and lower healthcare costs. Among these solutions are patient-focused care models, leading-edge data analytics and digital health technologies. Additionally, Capital Blue health and wellness centers provide in-person service and inspiration to help people reach their health goals.

Capital BlueCross was named Best in Member Satisfaction Among Commercial Health Plans in Pennsylvania by J.D. Power, and has scored higher than all health insurance providers publicly measured in the American Customer Satisfaction Index (ACSI) for five consecutive years (2014-2018). Capital BlueCross is an independent licensee of the BlueCross BlueShield Association. For more information, visit capbluecross.com. We also encourage you to connect with us on Facebook, check out our videos on YouTube and follow us on Twitter.

About Prime Therapeutics
Prime Therapeutics LLC (Prime) makes healthcare work better by helping people get the medicine they need to feel better and live well. Prime provides total drug management solutions for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and offers clinical services for people with complex medical conditions. Prime serves more than 28 million people. For more information, visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.

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SOURCE Capital BlueCross