New York-based insurer EmblemHealth is teaming up with Prime Therapeutics to rethink the pharmacy benefit experience for its members.
Emblem will tap into Prime's tech stack, which allows real-time referrals for specialty drugs instead of the more traditional network structure. In this model, it encourages competitive pricing for specialty products when ensuring members feel the savings directly, the insurer said in an announcement.
Prime's platform is powered by the technology built at Judi Health, formerly known as Capital Rx. Members will have access to real-time savings alerts, digital access to their pharmacy benefits card and personalized comparisons for their medications.
EmblemHealth will also tap Amazon Pharmacy as a home delivery provider, per the announcement. This provide more convenient options for members, who will also still have access to Prime's broader network of pharmacies, the insurer said.
Tanvi Patel, vice president and general manager for Amazon Pharmacy, told Fierce Healthcare that there's a growing number of insurers that, like EmblemHealth, are looking at more customized models for pharmacy benefits rather than a "one-size fits all types" approach that has been offered more traditionally.
Amazon, for instance, is also a partner in Blue Shield of California's redesign of its pharmacy benefits, which unbundles key services and leans on multiple companies to provide different elements.
Patel said that early conversations with the Emblem team dug into Blue Shield's model, which officially took effect at the beginning of this year, and the results it was seeing.
"They did their own research, and here we are with a model that looks very similar, where Emblem has been able to piece together benefits on behalf of their members that makes sense, rather than saying one solution must fit everybody, and that's where we come in," Patel said.
Ultimately, EmblemHealth said its goal was to create a simpler process that members can more readily navigate. The shift comes under the backdrop of rapidly growing pharmaceutical prices.
"We are dedicated to providing a simpler and more transparent experience to members who have diverse needs and rely on their medications for their health and wellbeing," said EmblemHealth’s chief medical officer, Daniel Knecht, M.D., in the release. "This strategic collaboration places our members at the forefront, ensuring they have an exceptional, convenient, and affordable solution that is both seamless and responsive to their unique healthcare journeys."