Prime Therapeutics tells Sunnyside trustees specialty drugs and neoplastics drove pharmacy costs; offers adherence and app-based savings
Summary
Prime Therapeutics reported roughly 1,500 members with plan-paid pharmacy costs around $1.9 million year‑to‑date, specialty spend near $788,000 and payer‑matrix savings of about $291,000; recommended adherence programs, PrimeCentral app and a hybrid payer‑matrix add‑on.
Prime Therapeutics presented the trust’s pharmacy review, highlighting specialty-drug concentrations and several operational savings opportunities.
Kelly Shane, account executive at Prime Therapeutics, said the membership is about 1,500 and that plan-paid pharmacy dollars were roughly $1.9 million year‑to‑date, producing a PMPM around $126. She described ingredient cost per day at about $4 and said four new drugs this period totaled roughly $281,000.
Kelly flagged a single neoplastics (cancer) utilizer as driving a notable spike in specialty spend and said specialty accounted for roughly $788,000 of cost; she reported 23 specialty utilizers with 14 funded cases and estimated payer-matrix savings at about $291,000. "Neoplastics is actually cancer. And I believe it's 1 utilizer," she said.
Recommended actions included rolling out the PrimeCentral mobile app to members (Kelly said it is free and can surface formulary alternatives), piloting an adherence program called Sempre Health (a low-touch outreach program tied to pharmacy co‑pay incentives), and considering a hybrid add-on to the payer matrix that could expand coupon/alternate funding options to capture additional savings over time.
Kelly offered follow-up materials (payer-matrix drug lists, appendix slides and a QR flyer for the app) and invited trustees to request supplemental data.
