Blues-backed pharmacy benefit manager Prime Therapeutics is expanding its partnership with Sempre Health nationwide after finding significant savings in a pilot program.
Blue Cross Blue Shield of North Carolina, a client of Prime, launched with Sempre in 2022. Sempre identifies the members that are taking preferred, single-source drugs to manage chronic needs and automatically surfaces discounts at the pharmacy counter.
Members also receive text message alerts when it's time for them to refill a prescription, with savings incentives that increase as they refill their key medications on time.
Over the past three years, the partnership with Blue Cross NC has enrolled more than 19,500 members and managed more than 70,000 refills, saving members $4.7 million. It's with these results under their belts in the initial collaboration that Prime decided to expand the relationship.
Chris Saliba, vice president of enterprise solutions at Prime, compared Sempre's model to safe driving discounts offered by many auto insurers. The program works similarly to ultimately encourage adherence to a medication regimen, he said.
That behavioral economics approach was part of the appeal for the Prime team, he said.
"So if you think about it, the more adherent you are the therapy, the more that you can save," Saliba said.
Sempre Health CEO Anurati Mathur told Fierce Healthcare that company's platform sits between the PBM or payer and manufacturer, aiming to better align two parties that are often at odds.
She said that Sempre has traditionally partnered more with health plans but is making a push to bring more PBMs on board.
"I think we now see the future of distribution for Sempre really coming through PBMs as a channel," she said. "We know that they have access to many more lives at scale, and that may be a better way for us to reach the patient and to increase our impact overall."
Looking ahead to the future, the partners see significant opportunity to build on this work together.
Saliba said there's plenty of untapped potential in using behavioral economics in health benefits to encourage patients to adopt healthier behaviors.
"I'm really excited to really test those, and we believe that our partnership could serve as a platform for expansion to other areas, as well as to test new innovations," Saliba said.