Real-time drug pricing and drug alternatives for new prescriptions

Blue Shield of California, in collaboration with Gemini Health, has introduced a new digital notification service designed to enhance prescription transparency and empower our plan members to make more informed decisions about their medications. Triggered when a new prescription is created, this service provides members with real-time drug cost information and potential lower-cost alternatives—giving them the opportunity to discuss options with their healthcare provider before heading to the pharmacy.

This feature is available for members with pharmacy benefits who have downloaded the Blue Shield mobile app and enabled push notifications. By delivering timely, personalized information, the service supports shared decision-making and promotes cost-effective medication choices.

How it works

When a provider selects a medication using ePrescribing within an electronic health record (EHR) system, a real-time prescription benefit check is initiated. This check returns detailed information—including drug costs, lower-cost alternatives, and coverage details such as prior authorization requirements—directly to the provider, displaying the information within the EHR. Simultaneously, the member receives a push notification to their cell phone with a link to a mobile-friendly website containing the same information.

This information can help members and providers engage in meaningful conversations about their medication and make informed decisions before the prescription is finalized and sent to the pharmacy.

Key details

• Eligible members are automatically enrolled in this program if they have the Blue Shield app installed in their smart phone or tablet and have opted in to (enabled) push notifications.
• Information is accessible to the member and provider for two weeks after the notification is received.

Benefits of using this app

1. Cost transparency – Members know what to expect before arriving at the pharmacy.
2. Real-time insights – Provides immediate access to drug pricing and alternative options, for both the provider and their patient.

Limitations

1. Not all prescriptions will trigger a notification. Some providers may not use EHRs, or their systems may not support real-time benefit checks.
2. Certain medications may be excluded or have limited alternative options which are based on clinical guidelines.