Edward Fotsch, M.D.

Problem Tech Solves

Prescription drug costs continue to climb each year. Patients experience the increases directly through prescription costs and indirectly through higher health plan premiums. Gemini’s services lower patient and health plan costs by putting patient-specific drug cost and lower cost alternative information where it’s most effective – in the hands of the prescriber at the time of prescribing. Gemini’s services lower prescription drug costs for patients by identifying lower cost, therapeutically equivalent alternative medications, based on the patient’s benefits, for new-to-therapy prescriptions, as well as for a patient’s existing medications, delivered to their prescriber within workflow. Alternatives are delivered to healthcare Providers via their Electronic Health Records (EHRs), as well as to Health System and Payer Pharmacists via a secure portal. This results in: • Significant savings for patients’ prescription costs, as recently reported by Blue Shield of CA (see attachment); • A patient’s doctor being able to recommend lower cost options and discuss them with the patient while they’re in the office so that any questions can be answered in person; and • Saved patient time and frustration from not knowing the costs of a prescription until the patient gets to the pharmacy to pick it up and learns how expensive it is. Gemini provides two services: Gemini’s Drug-Cost Decision-Support at Prescribing (DDP) provides real-time costs, lower cost alternatives, and savings for patients’ NEW prescriptions. Gemini’s Drug Savings Report (DSR) provides costs, lower cost alternatives, and savings for a patient’s EXISTING drugs, finding savings for all drugs at once.

Tech Brief

Gemini’s two services (DDP and DSR) are made up of .NET/PostgreSQL systems in a Terraform cloud infrastructure, broken into three components - the Configurable Alternatives Engine(TM) (CAE), the Gemini App, and MedOps™. These systems use API integrations with EHRs, intermediaries, and pharmacy benefit managers (PBMs). For new prescriptions, Gemini's DDP receives the drug that a prescriber types into the EHR via an intermediary (e.g. Surescripts). Gemini’s CAE identifies lower cost, therapeutically equivalent alternatives, based on patient-specific benefits. The original and alternative drugs are then sent to the PBM for pricing. The drug costs and calculated savings are then sent back to the prescriber, all within 2 seconds. For a patients’ existing drug(s), Gemini DSRs are generated (in off hour batches) and delivered in two ways. In the first way, the Gemini App APIs poll the EHR for upcoming appointments. For each appointment identified, Gemini’s CAE identifies lower cost alternatives for active drugs found in claims, gets the pricing and PA warnings as described above, and creates a DSR that is delivered back to the EHR, within workflow, prior to the appointment. In the second way, Pharmacists who work to reduce patient drug costs use Gemini’s interactive pharmacist desktop, MedOps™, to request a patient DSR and then, upon receiving and reviewing the generated DSR, make recommendations to prescribers for appropriate alternatives that will save the patient money. Gemini’s system technologies provide a robust and scalable solution with a lighter-weight means of integration and little to no set up for users.

Tech Differentiators

Most other systems only provide patient copays to prescribers for new prescriptions created in Electronic Healthcare Records (EHRs). Additionally, most systems have no way to document and report savings to their customers. Gemini services: 1) Provide lower cost, therapeutically equivalent alternatives to a prescriber's chosen drug for a new patient prescription and we provide them 2-3 times more often than our competitors, as reported by Surescripts in our 2020-2021 RTPB Report Cards.* This saves the prescriber from having to “hunt” for more affordable medication alternatives by entering alternative drug after alternative drug to see each of their costs and compare to the original medication's cost. 2) Provide total cost savings, not just patient cost, because payer savings result in reduced premiums for patients, 3) Provide lower cost alternatives for all of the patient’s existing medications via the patented Drug Savings Report (DSR) (not just new prescriptions), 4) Are also made available to Health System and Health Plan Pharmacists via secure portal to ensure that everyone working on the patient’s behalf has access to the same information, 5) Deliver documented drug cost savings identified in claims, as evidenced in the attached BSC press release, and 6) In late 2021, all active claims drugs (including those without savings) will be added to DSRs for EHR medication reconciliation purposes, increasing the safety of new patient prescriptions. Gemini services are free to prescribers and Health System/Payer/Retail Pharmacists and funded by Health Plans. *(Attachments are limited, but these are available to view upon request)


Blue Shield of California posted several press releases regarding their savings achievement of $20M using Gemini services (attached). Prescribers and Health System/Payer Pharmacists alike report the ease of use, the actionable information, and their satisfaction with helping patients save money. The following are quotes from recent press releases regarding Blue Shield of CA’s partnership with Gemini Health: “Many of my patients are concerned about the rising costs of prescription drugs. I worry they might decide to do without medication because they can’t afford it – and that can have serious consequences,” said Norman Rosen, M.D., a family practice physician at St. Joseph Heritage Medical Group. “With this new service, I have been able to save patients from $10 a month to a yearly savings of several thousand dollars by using medications that are therapeutically equivalent to those previously prescribed.” “The Blue Shield of California/Gemini Drug Cost Transparency Service TM tools empower unique collaboration between our doctors and Pharmacists to lower prescription drug costs with documented results, including drug cost savings for our patients,” said Dr. Raymond Chan, chief medical officer, Epic Management, LP. “Seeing drug and lower cost alternatives at prescribing, at each patient encounter and on demand by our Pharmacists allows us to use the technologies across the continuum of care to lower drug costs for our patients and their families,” said Christa Ellsworth, PharmD, Managed Care Pharmacists at Providence Medical Foundation in Anaheim, Calif.

Why Us

1. Millions in documented savings; 2. Patient’s ability to discuss/ask questions regarding alternatives during visit; 3. Savings in patient time/frustration from not knowing the cost of a prescription until it’s picked up; 4. Simplicity of set up and use, integrated directly within provider workflow; 5. Free to Health Systems.

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