Expert Oncology Drug Management Services - Prime Therapeutics
Care for your members living with cancer
Learn more about oncology
Cancer is a disease affecting 1 in 3 people in the United States that arises because of genetic changes and mutations causing the body’s cells to grow uncontrollably and spread to other parts of the body.1 Some cancers are best treated with surgery and others with drugs. Often, the best therapy is two or more treatments used together.
$3,413
Oncology medications account for half of total medical benefit drug spend, with an average claim cost of $3,413 for commercial plans.2
$223B
In 2023, oncology spend increased to $223B and is projected to reach $409B by 2028.3
See how Prime can help
The journey from diagnosis through treatment can be challenging. It can be difficult to follow treatment plans while managing the financial impact, social impact, mental health and drug side effects. End-to-end care is critical for helping patients maintain a high quality of life as they manage their cancer treatment.
Prime has an industry-leading breast cancer high drug cost claimant predictive model that uses customer medical and pharmacy claims data to identify the leading cancer drug spend category: breast cancer members who are predicted to have greater than $100,000 in drug spend over the next year.4 This predictive model output is available to customers for which Prime has integrated medical and pharmacy benefits data, available through our Insights+ reporting.
2
Cancer drug therapy is the second most expensive drug category based on Prime’s combined medical and pharmacy commercial claims data.5
1 in 125
One in 125 members had a cancer treatment drug claim in the most recent quarter.5
A comprehensive approach to savings
Drug management expertise
Our expertise in oncology drug management is unmatched. Where others offer tangential management programs, Prime gets to the heart of it to deliver true drug management.
Clinical excellence & policy flexibility
While some take a one-size-fits-all approach when it comes to medical necessity criteria, Prime offers the scale and breadth of clinical expertise to flex and meet your unique needs to drive preferred strategies.
Comprehensive suite of solutions
We offer more than just pre-service UM-focused programs to help you get efficient, cost-effective and clinically superior support. With solutions that span from pre-service to post-service, we help manage member health holistically.
Monitoring the changing landscape
We promote provider confidence, as Prime leverages the latest in FDA-approved indications for oncology drugs. And we provide peer-to-peer support. The result: provider satisfaction.
99%
Our 99% provider satisfaction is the highest in the industry.5 That’s because we deliver a single consolidated platform for all drugs, supporting a seamless provider experience and better member care.
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 What is cancer? | Cancer Basics. (n.d.). American Cancer Society. https://www.cancer.org/cancer/understanding-cancer/what-is-cancer.html
2 Medical Pharmacy Trend Report 2023. (n.d.). Issuu. https://issuu.com/magellanrx/docs/medical-pharmacy-trend-report-2023?fr=sYmEzZTY2MjgzNzc
3 Global Oncology Trends 2024: Outlook to 2028. (n.d.). IQVIA. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/global-oncology-trends-2024
4 Prime Therapeutics LLC. (2022, October 7). Prime Therapeutics presents real-world evidence-based research - Prime Therapeutics LLC. https://www.primetherapeutics.com/news/prime-therapeutics-presents-real-world-evidence-based-research/
5 Internal analysis, 2024