Pharmacy benefits management method and apparatus
First Claim
1. A pharmacy benefits management system comprising:
- a processor server having claim information relating to pharmacy benefits claims processed by a claims processing facility stored therein, said claim information including identification of drugs dispensed to patients, said processor server also having pharmacy benefits formularly information stored therein;
a provider server having pharmacy benefits plan structure information stored therein;
a management server having price information relating to drugs in various classes stored therein, said management server also having a processing module operative to correlate the claim information with the benefits plan structure information, the price information, and the formularly information to identify expenses associated with selected drugs in accordance with the pharmacy benefits plan structure information, alternative drugs in the same class as the selected drugs, and expenses associated with the alternative drugs; and
a communication channel connected between said processor server, said provider server, and said management server and being operative to communicate information between said processor server, said provider server, and said management server.
2 Assignments
0 Petitions
Accused Products
Abstract
A pharmacy benefits management system and method. A processor server has claim information relating to pharmacy benefits claims, and information relating to a claims processing formularly stored therein. A provider server has pharmacy benefits plan structure information stored therein. A management server has price information relating drugs in various classes and a processing module for correlating the claim information with the benefits plan structure information and the formularly information to identify drugs dispensed to patients, expenses associated with the drugs in accordance with the pharmacy benefits plan structure information, alternative drugs in the same class as the drugs and expenses associated with the alternative drugs.
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Citations
39 Claims
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1. A pharmacy benefits management system comprising:
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a processor server having claim information relating to pharmacy benefits claims processed by a claims processing facility stored therein, said claim information including identification of drugs dispensed to patients, said processor server also having pharmacy benefits formularly information stored therein;
a provider server having pharmacy benefits plan structure information stored therein;
a management server having price information relating to drugs in various classes stored therein, said management server also having a processing module operative to correlate the claim information with the benefits plan structure information, the price information, and the formularly information to identify expenses associated with selected drugs in accordance with the pharmacy benefits plan structure information, alternative drugs in the same class as the selected drugs, and expenses associated with the alternative drugs; and
a communication channel connected between said processor server, said provider server, and said management server and being operative to communicate information between said processor server, said provider server, and said management server. - View Dependent Claims (2, 3, 4, 5, 10, 11, 12, 13)
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6. A pharmacy benefits management system comprising:
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a processor server having claim information relating to pharmacy benefits claims processed by a claims processing facility stored therein, said claim information including identification of drugs dispensed to patients, said processor server also having pharmacy benefits formularly information stored therein;
a management server having a processing module operative to extract patient pharmacy benefits information from the claim information and display a list of pharmacy benefits provided to a particular patient, said processing module further being operative to prompt a patient to input a response to verify accuracy of the list of pharmacy benefits and to retain and process the response; and
a communication channel connected between said processor server and said management server and being operative to communicate information between said processor server and said management server. - View Dependent Claims (7)
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8. A pharmacy benefits management system comprising
a processor server having claim information relating to pharmacy benefits claims processed by a claims processing facility stored therein, said claim information including identification of drugs dispensed to patients, said processor server also having pharmacy benefits formularly information stored therein; -
a provider server having pharmacy benefits plan structure information stored therein;
a management server having price information relating to drugs in various classes stored therein, said management server also having a processing module operative to search the claim information based on a selected filter and display a list of patients whose pharmacy benefits correspond to the selected filter; and
a communication channel connected between said processor server, said provider server, and said management server and being operative to communicate information between said processor server, said provider server, and said management server. - View Dependent Claims (9)
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14. A pharmacy benefits management server comprising
means for downloading information from a processor server having claim information relating to pharmacy benefits claims processed by a claims processing facility, said claim information including identification of drugs dispensed to patients; -
means for downloading pharmacy benefits formularly information;
means for downloading pharmacy benefits plan structure information stored therein;
means for downloading price information relating to drugs in various classes stored therein; and
means for correlating the claim information with the benefits plan structure information, the price information, and the formularly information to identify drugs expenses associated with selected drugs in accordance with the pharmacy benefits plan structure information, alternative drugs in the same class as the selected drugs, and expenses associated with the alternative drugs. - View Dependent Claims (15, 16, 17, 18, 23, 24, 25, 26)
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19. A pharmacy benefits management server comprising:
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means for downloading claim information relating to pharmacy benefits claims processed by a claims processing facility, said claim information including identification of drugs dispensed to patients;
means for downloading pharmacy benefits formularly information;
means for extracting patient pharmacy benefits information from the claim information and displaying a list of pharmacy benefits provided to a particular patient;
means for prompting a patient to input a response to verify accuracy of the list of pharmacy benefits and retaining and processing the response. - View Dependent Claims (20)
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21. A pharmacy benefits management server comprising
means for downloading claim information relating to pharmacy benefits claims processed by a claims processing facility, said claim information including identification of drugs dispensed to patients; -
means for downloading pharmacy benefits formularly information;
means for downloading pharmacy benefits plan structure information;
means for downloading price information relating to drugs in various classes; and
means for searching the claim information based on predetermined selected filter and displaying a list of patients whose pharmacy benefits correspond to the selected filters. - View Dependent Claims (22)
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27. A pharmacy benefits management method comprising the steps of:
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downloading claim information relating to pharmacy benefits claims processed by a claims processing facility, said claim information including identification of drugs dispensed to patients;
downloading having pharmacy benefits formularly information;
downloading pharmacy benefits plan structure information;
downloading price information relating to drugs in various classes; and
correlating the claim information with the benefits plan structure information, the price information, and the formularly information to thereby identify drugs expenses associated with selected drugs in accordance with the pharmacy benefits plan structure information, alternative drugs in the same class as the selected drugs, and expenses associated with the alternative drugs. - View Dependent Claims (28, 29, 30, 31, 36, 37, 38, 39)
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32. A pharmacy benefits management method comprising the steps of:
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downloading claim information relating to pharmacy benefits claims processed by a claims processing facility, said claim information including identification of drugs dispensed to patients;
downloading pharmacy benefits formularly information;
extracting patient pharmacy benefits information from the claim information and displaying a list of pharmacy benefits provided to a particular patient;
prompting a patient to input a response to verify accuracy of the list of pharmacy benefits; and
retaining and processing the response in said prompting step. - View Dependent Claims (33)
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34. A pharmacy benefits management method comprising the steps of:
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downloading claim information relating to pharmacy benefits claims processed by a claims processing facility, the claim information including identification of drugs dispensed to patients;
downloading pharmacy benefits formularly information;
downloading pharmacy benefits plan structure information;
downloading price information relating to drugs in various classes;
searching the claim information based on a predetermined selected filter; and
displaying a list of patients whose pharmacy benefits correspond to the selected filters. - View Dependent Claims (35)
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Specification