New tool helps compare drugs, cost to patient

As consumers and health insurers grapple with ever-rising costs of prescription drugs, one Bay Area startup thinks it’s found a solution: Get doctors involved.

Sausalito’s Gemini Health has created an online “shopping” tool for doctors that, as they’re preparing to prescribe medications to their patients, generates a list of similar drugs and their out-of-pocket costs to patients — based on each patient’s insurance plan. Physicians can use the information to start conversations with their patients about which drug is best, while taking cost into consideration.

Gemini’s first customer is one of the state’s largest insurers, Blue Shield of California, which covers about 4 million people. The insurer is paying Gemini to introduce the service in the next two months to 6,000 California

doctors who treat Blue Shield members. Neither company would say how much the fee is; Gemini also declined to disclose details on the company’s funding.

Prescription drug prices are one of the fastest-growing expenses in health care, and consumers, health plans and employers are all shouldering the costs.

Doctors often don’t know how much a drug will cost a patient because patients pay different prices depending on what their insurance covers. Nearly a third of prescriptions are never filled, in large part due to cost, according to an analysis published in the Annals of Internal Medicine in 2014.

“I practiced medicine for 10 years and wrote 10,000 prescriptions and never once had any idea what those prescriptions cost the patients sitting in front of me,” said Gemini founder and CEO Dr. Ed Fotsch, a former emergency medicine doctor who started Gemini three years ago. “If there were three drugs I might (prescribe) for an infection or diabetes, I’d say, ‘I don’t really care among those three.’ But if someone said, ‘Choose the one that’s least expensive for me,’ I’d have no way to do that. We’re trying to solve that.”

Giving doctors access to information on pricing and alternative drugs that could treat the same condition — a tablet instead of an inhaled medicine, for instance — will help them make more informed decisions about what to recommend to their patients, said Salina Wong, Blue Shield’s director of clinical pharmacy programs.

Wong likens the tool to a price tag for drugs.

“It’s like going into a store,” Wong said. “If you really wanted that expensive purse for $1,000 as opposed to $30, you go in more informed.”

The pricing tool pulls information from each patient’s electronic medical records; his or her health insurance plan; Blue Shield’s pharmacy claims processor; and a database of about 75,000 prescription drugs.

The program can be integrated into a medical practice’s electronic health system. The tool is free for doctors and patients. The company said it is in talks with other Blue Cross and Blue Shield affiliates to expand the service to doctors in 17 other states.

Catherine Ho is a San Francisco Chronicle staff writer. Email: cho@ sfchronicle.com Twitter: @Cat_Ho