2018 PBMI Excellence Award Winners

This year we were excited to award eight organizations with a PBMI 2018 Excellence Award.  These organizations have demonstrated excellence in contributing to cost containment, care management, and quality improvement for the drug benefit and a new category this year for opioid management strategies.  Below are summaries of their winning programs/strategies.

Care Management Strategies

CVS Health

CVS Health is recognized for its ScriptPathTM Prescription Schedule tool.  This tool provides a complete view of the patient's medication information and helps simplify how to take these medications.  Through automatic system reviews of current CVS pharmacy information, instructions from prescribers, and clinical data, a clear and concise dosage schedule is generated showing the optimal times of day to take a medication.  Easy-to-understand icons help patients and caregivers while also enhancing patient safety.

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Southwest Airlines

Southwest Airlines is recognized for the results achieved by combining the evidence-based approach of a Specialty Guideline Management (SGM) program with their oncology program to implement a split fill program for 19 oncology drugs. Members saved money by paying half the cost of their copay for a two week first-fill of their prescribed medication. This enabled a short trial period for drug tolerability. In addition, this organization worked with medical vendors to minimize the number of days to access drugs (down from 21 to 3 days). In the case of one patient, this program yielded annualized savings of $284K.

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Texas Oncology

Texas Oncology is recognized for its Medically Integrated Pharmacy Care Model. Through this integrated care approach a healthcare team of providers (i.e., physicians, nurses, pharmacists, nutritionists, etc.) work together to review medical and pharmacy information to provide the right care to help patients’ achieve positive outcomes. Key program results include: improved medication adherence, avoidance of gaps in care, reduced treatment delay, and fewer adverse patient conditions due to drug therapy side effects.

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Cost Containment


HealthPartners is recognized for its mandatory Site of Care Program. Through outbound educational phone calls conducted by member service specialists (i.e., Pharmacy and Nurse Navigators), members were assisted with transitioning to an appropriate, lower-cost site of care within a 3-month grace period. To help reduce the cost of for the most common medical injectable drugs, HealthPartners recontracted with hospitals to obtain lower site of care locations. Over the first six months of the program, they recognized average savings of $7,500 per member, a 28.8% reduction in drug costs due to recontracts. The program also allowed >50% of members to continue medical service at their current site of care.

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Quality Improvement


Abarca is recognized for the improvements it helped achieve in Medication Therapy Management (MTM) and comprehensive medication review (CMR) performance for a Medicare Part D health plan. Abarca worked with the health plan to re-engineer their MTM program and improve CMR completion rates through integrated technology, analytics, and clinical expertise to deliver targeted interventions. In less than two years, the CMR performance improved from three to five stars and the plan achieved CMR completion rates of 84%.

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PersonalMed is recognized for its pharmacy certification (cCert) credentialing program. Through this program, pharmacies must adhere to rigorous standards (e.g., business practices, clinical practices, marketing and a sales, regulatory compliance). Certified organizations offer patients access to highly qualified compounding pharmacies that provide customized medications which are not ordinarily available. Over the past three years, PersonalMed’s compliance team has supported more than 3,000 pharmacies and worked collaboratively with over 300 pharmacies on an ongoing basis. Through these efforts, cCert, compounding pharmacists are able to assist prescribers solve clinical issues, help patients receive better care, and plan sponsors achieve cost savings.

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Opioid Management Strategies

Express Scripts

Express Scripts is recognized for its, Advanced Opioid Management Solution which manages new and acute opioid users, short-term or intermittent opioid users, patients on long-term/chronic opioid therapy, as well as those patients who may be overusing or abusing opioids. This unique solution influences behavior at each touchpoint. The program incorporates targeted calls from neuroscience Therapeutic Resource Center (TRC) specialist pharmacists who counsel patients, in the comfort of their home, about the safe use of opioid medications. In the initial 90-days, the program yielded significant results: 60% reduction in average day supply per claim for first-time opioid users, 96% of patients prescribed an opioid for the first time started with a 7-day supply or less, and 87% of patients initially prescribed a long-acting opioid were redirected to a safer short-acting medication.

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Prime Therapeutics

Prime Therapeutics is recognized for its Controlled Substance Management Program. This program includes several components which work in concert to identify and target individuals at risk of misusing controlled substances. Components of the program includes: Prime’s controlled substance score, prescriber outreach, and member interventions through its GuideHealth® Care program, predictive modeling, reporting, point of sale alerts, and utilization management tools. In the past five years, Prime has seen a 71% decline in opioid outliers among its commercial membership and a 16% reduction in total opioid claims per capita.

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