Prime Therapeutics and CoverMyMeds Help Lower the Number of High-Risk Medication Prescriptions for Seniors
Innovative pilot program proves electronic prior authorization helps avoid safety issues, save health plan costs and increase Medicare Part D Star ratings
ST. PAUL, MINN. – Nov. 23, 2015 –Medicare beneficiaries were 57 percent less likely to receive prescriptions that may cause potential health risks as a result of a pilot program developed by Prime Therapeutics (Prime), one of its health plan clients, and CoverMyMeds, the nation’s largest electronic prior authorization (ePA) platform. The program addresses the issue of high-risk medicines for members age 65 and older by alerting prescribers of risks during the ePA process. The organizations announced the success of the innovative pilot program today.
Health issues associated with high-risk medicines for this age group are a significant concern in the U.S. And, the concern is one that will continue to grow. An average of 10,000 baby boomers will turn 65 every day until the year 2029. Prime, its health plan client and CoverMyMeds took direct aim at the growing concern by working together on this preventative effort.
Before the pilot began, Prime and its health plan client believed that high-risk medicine alerts and options for alternatives at the point of prescribing would result in prescribers choosing a safer, more appropriate drug. During the pilot program period – which took place in the first half of 2015 – Prime’s real-time ePA messaging was applied to 843 high-risk medication prescription requests for adults 65 and older covered by the health plan. Of the total number of prescriptions initially submitted, prescribers acted on the program’s recommendations to consider an alternate, lower risk medication within the CoverMyMeds portal more than 50 percent of the time, significantly reducing the number of patients at risk.
“Utilizing the CoverMyMeds solution in a way that directly impacts the health and well-being of patients is the core of our company,” said Matt Scantland, co-founder of CoverMyMeds. “Working with Prime and its health plan client takes this founding idea a step further, preventing future health risk in an evolutionary way.”
In this pilot, the safer alternatives chosen more than 50 percent of the time decreased the number of high-risk medications ultimately provided to adults over 65. Both the Centers for Medicare and Medicaid Services (CMS) and the Healthcare Effectiveness Data and Information Set (HEDIS) have quality measures that focus on decreasing the use of high-risk medications in the elderly. The CMS Star ratings measure is defined as the percentage of members receiving more than two prescription fills of a high-risk medication. For this measure, a lower percentage is better. Prime has helped its health plan clients move to 5 Stars for many CMS Star ratings measures through a variety of programs focused on member and safety quality, including the ePA pilot.
“Our members’ safety and superior overall experience is at the heart of everything we do,” said Scott Fries, Prime’s senior vice president of government programs. “We wanted to test our ability to help our members avoid safety issues associated with high-risk medications, especially when we know there are safer options. The pilot results clearly show how collaboration and innovation can work together to keep members safe, improve health outcomes, and positively impact Star ratings.”
CoverMyMeds is the leader in Electronic Prior Authorization (ePA) and one of the fastest growing healthcare technology companies in the U.S. The company helps physicians, pharmacists and their staff complete ePA requests for any drug and all health insurance plans. CoverMyMeds technology integrates with more than 45,000 pharmacies, 360 EHRs, and Payers representing 72 percent of U.S. prescription volume to create the most efficient ePA strategy for all participants. With millions of ePA requests processed each month, CoverMyMeds is the only vendor using the NCPDP ePA standard at scale. For more information, visit www.covermymeds.com.
About Prime Therapeutics
Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members, offering clinical services for people with complex medical conditions. Headquartered in St. Paul, Minn., Prime serves more than 26 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized as one of the fastest-growing private companies in the nation. For more information, visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.