Blue Cross and Blue Shield of New Mexico (BCBSNM) utilizes Prime Therapeutics LLC as our pharmacy benefit manager to administer our pharmacy program to help contain rising drug costs and maintain and improve the quality of care delivered to members.
Prime Therapeutics is responsible for:
- Processing and paying Rx claims
- Developing and maintaining the drug formulary
- Contracting with pharmacy networks
- Negotiating discounts and rebates from manufacturers
BCBSNM employs a number of industry-standard management strategies to ensure appropriate drug utilization and the use of cost-effective drug therapies. These strategies include:
- Formulary management
- Benefit design modeling
- Specialty pharmacy benefits
- Clinical programs and tools aimed at reducing inappropriate prescribing (utilization management programs such as prior authorization and step therapy)
All strategies and services are necessary to improve the value of our drug benefits, monitor drug safety and ultimately improve the health outcomes of our members.
Prime Therapeutics LLC is a pharmacy benefit management company. BCBSNM contracts with Prime Therapeutics to provide pharmacy benefit management and other related services. BCBSNM, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC.