Maximize Cost Savings with Our High-Cost Clinical Management Solutions - Prime Therapeutics
Help your members on high-cost clinical drugs
Learn about high-cost clinical conditions
Anticoagulants
Anticoagulants are drugs that stop your blood from clotting too easily, breaking down existing clots or preventing clots from forming. These drugs can help prevent life-threatening conditions like strokes, heart attacks and pulmonary embolisms.1
Growth hormones
Growth hormones are produced in the anterior pituitary of the brain. Growth hormones are tightly regulated through several complex mechanisms in response to stress, exercise, nutrition, sleep and growth hormone itself. There are short-acting, long-acting and unique indications.2
HIV
Human immunodeficiency virus (HIV) attacks the body's immune system. Without treatment, it can lead to Acquired Immunodeficiency Syndrome (AIDS). Once people get HIV, they have it for life. But proper medical care can control the virus. People with HIV who get on and stay on effective HIV treatment can live long, healthy lives and protect their partners.3
Migraines
Migraines are headaches that can cause severe throbbing pain or pulsing sensation. They are often accompanied by nausea, vomiting and extreme sensitivity to light and sound. Attacks can last for hours to days, and the pain can prevent people from engaging in daily activities.4
9.6%
Anticoagulants, growth hormones, HIV drugs and migraine drugs represent 9.6% of all drug spend across medical and pharmacy benefits within Prime’s commercially insured population.5
3 in 100
Three in every 100 of Prime’s commercially insured members had a drug claim in these four categories.5
A comprehensive approach to savings
Clinical rigor
Help your members get the right treatments with comprehensive policies, proactive pipeline monitoring and rigorous utilization management (UM).
Proactive support
Empower pharmacists to approve a coverage exception to avoid any lapse in therapy when there are no other appropriate covered agents.
Formulary management
Our formulary management strategies (e.g., NetResults) drive to the lowest cost of care and balance exclusions as applicable.
Choose what works best for you and your members
Footnotes
*All brand names are property of their respective owners.
**The programs listed are not available to all clients. Please check with your representative if you are interested in learning more.
1 Professional, C. C. M. (2024, May 1). Anticoagulants. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/22288-anticoagulants
2 Brinkman, J. E., Tariq, M. A., Leavitt, L., & Sharma, S. (2023, May 1). Physiology, growth hormone. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK482141/
3 About HIV. (2024, January 24). HIV. https://www.cdc.gov/hiv/about/index.html
4 Migraine - Symptoms and causes - Mayo Clinic. (2023, July 7). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201
5 Internal analysis, 2024