Blue Shield of California patients and their doctors can now compare drug prices right in the exam room

Published October 10, 2019

Patients want the best prescription drug at the best price for their condition. And physicians say they want to provide that too, according to The Commonwealth Fund.

But what often hinders a physician’s decision-making is a lack of information. Doctors may not know the cost of a medication they want to prescribe, and they may not have access to a patient’s health insurance information to know what a patient may have to pay out-of-pocket for that drug.

A lack of information, a steady rise in prices
Alison Lum, vice president of pharmacy services at Blue Shield of California (BS California), acknowledges the problem. “Doctors have struggled for many years to provide actionable information at the point of prescribing,” says Lum. 

The issue is more important than ever, as prescription drug costs continue to rise. A recent Pew Trusts analysis found that U.S. consumers spent nearly $400 billion on prescription drugs in 2018, up more than $100 billion dollars since 2013. Some drug prices have gone up substantially more than others, leaving consumers with hard choices about how to pay for the medications they need.

Drug price information right in the doctor’s office
To help address this, BS California has rolled out new services for doctors that provide real-time information about the cost of prescription drugs. The tools, “Drug-Cost Transparency Services™,” are a collaboration between BS California and Gemini Health that plug into existing electronic health records systems to enable doctors to see a patient’s specific health plan benefit information, including actual out-of-pocket costs for medications. They can identify alternative but clinically equivalent medicines that might be lower cost based on a patient’s benefits. Doctor and patient can then discuss the alternatives right in the doctor’s office – before a patient heads to the pharmacy. It’s information not typically available through standard electronic prescribing technology. 

The program was piloted at Providence St. Joseph Health system, and in the first couple of months the initiative delivered an estimated $100,000 in annualized savings in patients’ out-of-pocket costs. The services have since been rolled out to more than 10,000 prescribers across Northern and Southern California.

“Many of my patients are concerned about the rising costs of prescription drugs,” says Dr. Norman Rosen, a family practice physician with St. Joseph Heritage Medical Group. “I worry they might decide to do without medication because they can’t afford it, with serious consequences.” He says he’s using BS of California's service to deliver the same quality of care and has been able to save some patients several thousand dollars, “using medications that are therapeutically equivalent to those previously prescribed.”

Patients could leave a doctor’s office with a prescription for a more affordable medication that works just as well or better than what was originally prescribed.

Empowering doctors and patients with information
"Our nonprofit mission is to help ensure Californians have access to quality health care at an affordable price, and that includes prescription drugs," says Dr. Terry Gilliland, BS of California's executive vice president of healthcare quality and affordability. "The collaboration with Gemini and Providence St. Joseph Health is an example of making that vision a reality by using latest technologies to solve one of the thorniest problems in our healthcare system – skyrocketing drug costs."

Blue Shield of California is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.