Providers get patient-specific drug-cost comparisons for prescriptions using their electronic health record system
SAN FRANCISCO (April 25, 2018) – Healthcare providers in California can now use a new Drug-Cost Transparency ServiceTM to view patient-specific lower-cost alternative medicines and compare prices while meeting with patients in their office. This innovative service is the result of a collaboration between Blue Shield of California and Gemini Health, LLC, based in Sausalito, Calif.
Providers can use their existing electronic health record (EHR) system to view drug and comparative pricing information during patient visits to determine which medications are covered for their Blue Shield patients.
Gemini’s technology is unique because it provides actionable information at the point-of-care to a prescriber before a medication decision is made and the prescription is sent to the pharmacy. Prescribers receive the following information in real time:
- Actual patient out-of-pocket cost information for the selected medication that’s based on patients’ health plan benefits and formulary.
- Accurate total drug cost savings (based on actual payer costs and rebates) for up to three lower-cost, dose-matched clinically equivalent alternative medications.
- Accurate patient cost and total savings for alternative pharmacies (e.g. specialty or mail-order).
- Whether any prior authorization is required, and/or shows alternative medication(s) that don’t require a prior authorization.
- Any coverage notices that would create pharmacy call-backs to the prescriber’s office.
“We are working with Gemini Health to bring real-time drug price transparency to providers, so they can deliver cost-effective care for their patients,” said Jeff Bailet, M.D., executive vice president of Blue Shield’s Health Care Quality and Affordability. “As a nonprofit health plan, Blue Shield is committed to ensuring that all Californians have access to high-quality, affordable health care. This new service is a key step toward making that a reality.”
Filling the information void
Today, most healthcare providers prescribe medications in a cost-information void. They don’t have real-time information about their patient’s pharmacy benefit and formulary; the patient’s financial responsibility for prescribed medications; lower-cost alternative medications; or which prescribed medications require prior authorization.
“Providers need information that helps them make informed choices on behalf of their patients, especially those who have deductibles or drugs subject to co-insurance,” said Randy Barnes, executive vice president of NewCrop, an electronic prescribing firm that will be delivering the Gemini Drug-Cost Transparency ServiceTM to its nearly 6,000 California prescribers. “With this service, they will get the level of detail they want for prescription-drug prices and pharmacy benefits while they are using their EHR in their usual work flow.”
How Gemini works
Distinctive from other similar services, Gemini’s technology helps identify the most relevant lower-cost alternative medicines for busy prescribers. Gemini also works with Blue Shield to include plan and benefit-specific information on the actual out-of-pocket costs for the patient, as well as the total drug cost. This information is not currently available through standard e-prescribing technology.
The Gemini Drug-Cost Transparency ServiceTM can reduce pharmacy call-backs to the provider’s office to resolve drug coverage issues to enhance provider productivity, while helping to identify the treatments with the lowest out-of-pocket costs for the patient to improve patient satisfaction and adherence.
Gemini’s Drug-Cost Transparency ServiceTM is available to Blue Shield of California’s network physician groups with no additional cost.1
“The collaboration supports the Federal government’s recent call for health-care pricing transparency,” said Edward Fotsch, M.D., Gemini CEO. “While drug prices continue to rise unabated – some with huge increases even for generics – providers have had little information about the actual cost of drugs for their patients, making it difficult for them to determine the most cost-effective treatment options before patients go to the pharmacy. Gemini Health delivers valuable information that providers can use to actively lower drug costs.”
About Blue Shield of California
Blue Shield of California, an independent member of the Blue Cross Blue Shield Association, is a nonprofit health plan with 4 million members, 6,800 employees and more than $17 billion in annual revenue. Founded in 1939 and headquartered in San Francisco, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare health care service plans in California. The company’s mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield has contributed more than $500 million to Blue Shield of California Foundation. Contact your local agent or broker about Blue Shield of California products and services or visit www.blueshieldca.com.
About Gemini Health
Gemini Health LLC delivers drug and alternative cost transparency to prescribers to reduce drug and administrative costs for patients, providers and payers. The Gemini Drug-Cost Transparency ServiceTM delivers decision support for busy prescribers integrated into Electronic Health Record workflow, including actual patient-specific costs of drugs selected by a physician, as well as lower cost alternative drugs and pharmacies when applicable, based upon the patient’s pharmacy benefit, formularies, and related health plan coverage details. Gemini is working with key provider and payer partners, with a focus on several Blue plans, including in California with Gemini’s lead partner, Blue Shield of California. For more information, visit www.gemini.health.
1 Indirect costs to physician groups may be associated with resources needed for EHR integration and provider training.