Prime Therapeutics expands Sempre Health partnership to rein in drug costs

Pharmacy benefit manager Prime Therapeutics is expanding its partnership with Sempre Health, a company that applies discounts at the pharmacy counter for people taking single-source drugs for chronic conditions. 

The initiative, focusing on expanding access to behavior-based medications, is meant to give clients new ways to help their commercial members save money and stay on therapy.

Recent data from Prime's client, Blue Cross and Blue Shield of North Carolina, shows positive results from the model. Since launching in 2022, the program has enrolled more than 19,500 patients, supported over 70,000 prescription fills and generated $4.7 million in member savings. 

The initiative also achieved a Net Promoter Score of 98 and increased medication adherence by 15 percentage points, according to Prime.

"The outcomes with Blue Cross NC and Sempre show exactly why we invest in initiatives like this: to make healthcare more affordable, improve adherence and support healthier lives,” said Christopher Saliba, vice president of Enterprise Solutions at Prime.

WHAT'S THE IMPACT 

The companies will be expanding the model nationwide.

Prime shared data from KFF showing that nearly 30% of Americans skip prescriptions due to cost, driving an estimated $290 billion in avoidable medical expenses each year. 

Sempre's behavior-based pricing model rewards healthy behaviors like timely refills and sustained adherence through partnerships with health plans, life science companies and pharmacy benefit managers (PBMs), including Prime.

"Too many people are forced to choose between paying their bills and filling their prescription," said Anurati Mathur, CEO of Sempre Health. "Our work with Prime Therapeutics means that millions of people can stay on their life-saving medications without financial strain. We're thrilled to scale this impact nationwide.”

THE LARGER TREND 

Prime Therapeutics is one of the largest PBMs in the country, with about a 10.3% market share, according to American Hospital Association data published last fall.

Along with CVS Health (with a 21.3% market share), OptumRx (20.8%) and Express Scripts (17.1%), the country's four largest PBMs control roughly 70% of the national market.

Michigan Attorney General Dana Nessel filed a lawsuit against Express Scripts and Prime Therapeutics in May, claiming the two pharmacy benefit managers allegedly engaged in anticompetitive conduct that harmed independent pharmacies in the state.

According to the lawsuit, the PBMs allegedly formed an unlawful agreement that suppressed reimbursement rates to independent pharmacies, enabling them to pull in profits at the expense of independent pharmacies.