Gemini Health is the only RTPB and Drug Cost Transparency service that offers the CAE – Configurable Alternatives Engine, which is a highly curated drug database and a Payer-configurable alternatives rules engine.
Drug-Cost Decision-Support Services Platform
Gemini Health’s services are all based on our service platform comprised of the Configurable Alternatives Engine (CAE) and the Claims-based Reporting Engine (CRE).
CAE – Configurable Alternatives Engine
Gemini began designing the CAE in 2016 to reduce prescription drug costs by using an algorithm to deliver patient-specific lower cost alternatives to busy prescribers. The CAE is configurable for each Payer and takes in and processes multiple drug compendia, member eligibility files, claims files, payer formularies, preferred and excluded drugs, payer rules, and other benefit components. Using all of this data and a drug database that has been carefully and highly curated over several years, the CAE matches up to three therapeutically equivalent, dose-matched lower cost alternatives, based on a patient’s specific benefit, sends all four drugs to the appropriate PBM for pricing and coverage alerts, then sends the results in a transaction to the clinician for review. For Gemini’s advanced Real-Time Prescription Benefit (RTPB) service Drug-cost Decision-support at Prescribing, or DD-P, this all happens typically in under 2 seconds.
Co-developed with Gemini’s BCBS customers, the CAE has evolved from one service to five services after it became apparent that RTPB at prescribing was an incomplete approach to drug cost reduction. Now serving not only prescribers, but managed care and payer pharmacists, payer pharmacy vendor professionals, and members, as well, Gemini services provide a comprehensive program that has resulted in over $100M in savings for patients, payers and at-risk providers. The Gemini MedTherapy Advisory Group oversees the maintenance and enhancement of the CAE drug database, including safety and efficacy reviews, with input from Gemini clinicians, BCBS customer clinicians, and thousands of end users.
Drug-Cost Decision-Support Services
Gemini Health provides a suite of Drug-Cost Decision-Support Services (DDS) to increase cost-effective prescribing and thereby lower drug costs. Gemini Services are payer- and patient-specific and have a proven ability to lower drug costs for members and health plans.
Services provided include:
- Drug-Cost Decision-Support @ Prescribing (DDP) for new to therapy medications, and
- Drugs & Savings Reports ® (DSR) for existing medications
Drug-Cost Decision-Support at Prescribing (DD-P) – New to Therapy Medications
Drug-Cost Decision-Support at Prescribing (DD-P) provides real-time, patient-specific drug and drug alternative costs, either alternative medications or alternate fulfillment options, to prescribers at the point-of-care integrated into their Electronic Health Record (EHR) workflows (a.k.a. Real-Time Prescription Benefits).
Gemini DD-P Services work in conjunction with other Real Time Prescription Benefit (RTPB) services in the market and focus on savings and value for the payer. Gemini Services go beyond other RTPB services in the following ways:
- Gemini services deliver lower cost alternative drugs at prescribing three times more often. Providers will only select a lower cost alternative if one is provided.
- Gemini services offer better quality alternative medications as reported by provider users. Gemini alternatives are vetted regularly by the MedTherapy Advisory Board and by the many PharmD users of related Gemini services, providing invaluable feedback and continuous quality improvement.
- Gemini uniquely provides total savings (i.e., total savings based on the difference of the total cost of the existing medication and the alternative) and patient costs for all alternative medications in addition to the patient cost for the chosen medication.
- Gemini validates that the payer’s intended messages related to cost, and coverage are being delivered to their provider partners in EHRs via ‘chairside’ visits.
Gemini DDP Services also interface with Member Web Portals and Comprehensive Medication Management platforms.
DSR – Drugs & Savings Report – Previously Prescribed Medications
The DSR service identifies a member’s existing medications in claims and identifies lower cost, clinically equivalent alternative medications based on a patient’s pharmacy benefit plan structure and corresponding formulary. The service also identifies Additional Active Medications to ensure a complete drug list is provided.
- DSR – Drugs & Savings Report – Electronic Health Record (DSR-E) – Provider’s review DSRs with their patients during their appointments. DSRs are automatically triggered by an upcoming appointment, sent to the patient’s chart, and are available within the provider’s EHR workflow for the patient’s visit.
DSRs are further enhanced from the addition of MedOps(SM) and the Gemini Score(SM)
MedOps Pharmacist Desktop Application
MedOps is a patented web-based interactive Gemini application that allows users to request medication lists with lower cost alternatives (DSR) based upon member lists, medication type or NPI. MedOps empowers users to rapidly identify savings opportunities for existing medications and communicate these to prescribers to generate savings/ROI.
The Gemini Score for drugs indicates the likelihood that a drug will be changed to lower cost therapy based upon actual prescriber behavior as documented in tens of millions of Gemini transactions. The Gemini score helps identify drugs and prescribers with the greatest savings potential. Using the Gemini Score in the MedOps application allows users to sort by Gemini score to focus quickly on those drug alternatives that will result in the highest success.
Gemini’s Patented Services Provide More Opportunities to Switch Patients to More Optimal Medications.
Gemini has an integrated suite of five drug cost transparency services, far beyond standard PBM RTPB services, that offer lower cost alternatives at 5 different Patient “touch points” where patients are interacting with healthcare providers regarding their prescription drugs. Additionally, providing lower cost alternatives 5 times more than the industry average enables us to provide 10 times the industry savings.
Additionally, you can improve your Star Ratings even further by implementing Gemini service enhancements SPS – Shared Patient Savings and AMR – Advanced Medication Review.