By David Gambino, Vice President and Chief Pharmacy Officer

According to the Kaiser Family Foundation, one in four people taking prescription medications say they are having difficulty affording their medications. And if a patient can’t afford a prescription, most either won’t take it or will lower the dosage by cutting pills in half.

Yet effectively treating any illness - chronic or acute – with a prescription requires that patients follow the recommend dosage and duration. And higher drug prices are holding patients back from adhering to their medications. Consider these startling facts about prescription drug costs:

• Kaiser also found that about three in ten (29%) adults reported not taking their medicines as prescribed at some point in the past year because of the cost.
• Adjusting for inflation, Americans spent $90 per person, per year for prescription drugs in 1960—which ballooned to $1,025 per person, per year in 2017, based on a report from Peterson-Kaiser Health System Tracker.

Giving Doctors a Powerful Tool to Lower Prescription Costs 

Often, the first time a patient learns about the cost of a prescription medication is at the pharmacy counter. And patients aren’t alone when it comes to not knowing the costs of prescription drugs. Traditionally, doctors aren’t aware of the prices of the drugs they prescribe, whether they are covered by patients’ insurance, or how much a patient will pay in out-of-pocket costs.

The increasing cost of prescriptions and lack of transparency drove Horizon to bring doctors who participate in Horizon’s network an innovative solution from Gemini Health. The software provides prescribers with what is known in the industry as Drug-Cost Decision-Support at Prescribing (DDP). It delivers up-to-date medication and alternative cost information to doctors via patients’ electronic health records. All pertinent information is available real-time and is accessible during a patient’s appointment. Using this platform, doctors can quickly and easily get patients the right medication at the best price.

Since the Gemini Health DDP was launched in March, its use among doctors has grown steadily as they recognize the convenience of using the platform and understand the value of helping their patients reduce out-of-pocket costs. About 240,000 prescriptions in total have been checked through the Gemini Health DDP – amounting to more than 2,000 prescriptions per day.

Besides helping their patients manage their out-of-pocket costs, doctors see an additional benefit. By checking a prescription through the system, doctors and their staffs face fewer administrative steps and avoid time consuming pharmacy call-backs when changes are required or sought by patients looking to substitute a lower cost alternative. The system also alerts doctors when a particular prescription requires prior authorization. Often that information only surfaces when a patient visits the pharmacy only having to return later to obtain their prescription once the authorization is issued.

Lower Costs are Just a Click Away 

Gemini Health integrates with patients’ electronic medical record (EMR). It works with an existing e-prescribing software used by doctors, called Surescripts Real-Time Prescription Benefit, to deliver patient-specific drug benefit and cost information at the point of care. The doctor is provided with a list of current medications specific to each patient, his or her insurance information and out-of-pocket costs, along with a list of up to three lower-cost alternatives and the pharmacies where they are available.

Gemini Health offers the potential for considerable savings. Consider the example of a commonly prescribed cholesterol-lowering medication and the potential savings Gemini could help provide if a similar generic option were prescribed instead. A patient could potentially save more than $250 with each prescription filled.

The real-time reporting available through Gemini also helps doctors and patients reduce confusion, frustration, costs and time because:

• There can be drastic differences in the cost of drugs, even from visit to visit as brand-name drugs go off patent and may be replaced with lower-cost generics.
• Patients change their health plans and health plans change their drug formularies (drugs that are covered by insurance along with copay costs.)
• New drugs come on the market.

At launch in March, Gemini’s DPP was available to more than 2,000 New Jersey providers and over 10,000 out-of-state providers. Collectively these providers account for more than one million prescription claims annually. Horizon will continue to add additional providers both in and outside of New Jersey throughout 2019 and expand this service to Medicare members in the near future.

Doctors can work with their IT team and EMR or Superscripts account managers to turn on or add the Gemini Health DDP on their EMR systems. They can also request a demo from one of these managers to see firsthand how the platform works. 

Through investments in technologies like Gemini Health, Horizon aims to make prescriptions – and all of health care - more affordable so our members can take the medicines they need to achieve their best health.