Blue Shield of California is teaming up with Gemini Health to roll out a new member tool that offers greater transparency at the pharmacy counter.
The tool, called Price Check My Rx, will be available in the insurer's existing member app, allowing members to see in real time the out-of-pocket price for any new or refilled prescriptions submitted by their provider and covered under their pharmacy benefits.
When the prescription is submitted electronically, the platform will send the member a push notification that prompts them to look at the pricing details and explore alternatives, including low-cost options, if they prefer. Jigar Shah, chief marketing and strategy officer for Blue Shield, told Fierce Healthcare that the tool fits within the payer's broader goal of simplifying the patient experience.
It gives members critical data at the point of care, allowing them to have a dialogue with their provider in an informed way, Shah said.
He said it's "that whole notion of like, pulling it forward and ending the guesswork, because you know exactly what it's going to cost you by switching to generic, and how much you're going to save."
In addition, the notifications live within the member app for 14 days after the initial send, so even if they miss it during their visit, they are still able to review options and reach back out to their doctor afterward.
Shah added that the team has worked with Gemini Health for many years on other projects, so it was a clear win as a partner for Price Check My Rx.
The offering is within the insurer's broader Pharmacy Care Reimagined initiative, which has also centered transparency in its approach. Under this effort, Blue Shield has launched a new model for pharmacy benefit management that leans on multiple vendors to provide a piece of the puzzle where they most excel, rather than securing a bundle of all services from a single PBM.
That new model officially launched for clients on Jan. 1, and the insurer said in the announcement that it has already seen positive results, especially around increased transparency.
Shah said Blue Shield is also leaning into a digital-first strategy with programs like Price Check My Rx, as well as its partnership with Zocdoc, which was announced in June. The thinking is rooted in human-centered design and in building tools that members will genuinely use.
For instance, with the new pharmacy offering, the team had to consider how to ensure that the nudges would encourage member behavior rather than simply being something they ignore, Shah said.
He added that while it's too early in the tool's life to have hard data on how it's working, in the first few weeks of its availability the team has sent out thousands of pings to members without receiving any calls back, which indicates that its usability is high, he said.
He said that as the Blue Shield team are themselves consumers of healthcare, they're frequently confronted directly with the lack of simplicity in the system. And encountering those headaches drives the development of tools like Price Check My Rx.
"Every time any one of us run into these issues, we're like, 'Why isn't this simplified? Let's just go simplify this,'" Shah said.