Priority Health Pharmacy Initiatives Save $50 Million over 5 Years

GRAND RAPIDS, Mich.–(BUSINESS WIRE)–As rising pharmacy costs continue to plague the health system, Priority Health’s pharmacy management initiatives have protected its members while keeping costs far below the national average for five years. The 4% savings equates to nearly $10 million per year and more than $50 million over five years.

“Pharmacy is one of the critical components that make up the cost of health care”

“Pharmacy is one of the critical components that make up the cost of health care,” said Kimberly K. Horn, president and CEO for Priority Health. “It’s an area we have committed significant resources to and created significant savings from, and in-turn, passed those savings along to our customers through lower premium increases.”

The facts around pharmacy are staggering, especially if you consider that each day Priority Health:

  • Processes 15,000 prescriptions with a total price tag of $1 million
  • Approves new specialty drugs that often cost up to $35,000 annually for a single patient (or member)
  • Pays for brand name drugs that account for 75 percent of costs and annual price increases of 8-10 percent
  • Reviews specialty drugs that can account for 20 percent of an employer’s health care costs

“Despite significant cost increases in pharmacy, Priority Health has developed programs that not only reduce costs and improve the quality of care but also deliver an exceptional customer experience,” adds Horn. “We distinguish ourselves by working closely with physicians, our staff pharmacists and our customers to create programs that deliver better health care outcomes and lower out-of-pocket costs.”

Employers and members see the greatest benefit of Priority Health’s innovative approach to health care when the medical plan and pharmacy plan are linked. By analyzing claims and pharmacy data, Priority Health has been able to ensure that customers get the safe and appropriate care. The company reviews pharmacy claims in “real-time” to determine whether a member is experiencing significant health issues and needs additional assistance. Once identified, these members are enrolled in its award-winning case and disease management programs.

Priority Health’s generic drug utilization continues to deliver significant savings. Nearly 80 percent of the prescriptions filled by its customers are generics. The company also offers:

  • A network of 60,000 pharmacies nationwide to provide services
  • Money saving benefit designs: 2-tier, 3-tier and 3-tier with specialty drug management
  • Low or no dispensing fees
  • Pharmacy case management services promote safety, effectiveness and cost-savings
  • A comprehensive support program that includes case management services for employees with chronic medical conditions
  • Expert resources, including a panel of physicians and pharmacists, who collaborate to build an approved list of safe, effective, FDA-approved medications and therapy management programs
  • A searchable, online approved drug list to help members determine if their prescriptions are covered and identify costs
  • Cost-sharing options that promote sensible prescription choices

More information about Priority Health’s pharmacy programs and success with managing costs is available on

About Priority Health:

Priority Health is an award-winning health plan nationally recognized for creating innovative solutions that impact health care costs while maximizing customer experience. It offers a broad portfolio of products for employer groups, individuals and Medicare and Medicaid. As a nonprofit company, Priority Health serves more than 600,000 people and continues to be ranked among America’s best health plans by the National Committee for Quality Assurance.


Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.