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Method for conducting prescription drug co-payment plans

  • US 20040073457A1
  • Filed: 06/27/2003
  • Published: 04/15/2004
  • Est. Priority Date: 06/27/2002
  • Status: Active Grant
First Claim
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1. A method of providing prescription benefits to subscribers under a plan, comprising the steps of:

  • a) identifying a sponsor for a prescription benefits plan;

    b) designing the prescription benefits plan, to include a formulary of preferred medications;

    c) identifying at least one pharmacy that;

    i) participates in the prescription benefits plan, ii) receives prescriptions for medication and prescription benefit claims from subscribers, and iii) fulfills the prescriptions for a predetermined price;

    d) identifying at least one eligible subscriber having a valid credit or debit account with a creditor or institution and wishing to participate in the prescription benefits plan;

    e) enrolling each eligible subscriber who wishes to participate in the prescription benefits plan;

    f) generating an eligibility profile for each subscriber;

    g) establishing a prescription benefits manager to administer the prescription benefits plan;

    h) establishing a prescription claims processor that;

    i) receives claims for prescription benefits from a participating pharmacy;

    ii) adjudicates the claims in accordance with the subscriber'"'"'s eligibility profile; and

    iii) upon approval of a claim, charges the subscriber'"'"'s credit account for accepted claims, the amount of the charge being equal to the price of the prescription minus a predetermined co-payment which is tendered by the subscriber to the pharmacy at the time of fulfilling the prescription;

    i) a first payment, made by the creditor to the prescription benefits manager, the first payment being equal to the amount charged to the subscriber'"'"'s account minus a first predetermined service fee to be retained by the creditor;

    j) a second payment, made by the prescription benefits manager to the pharmacy, the second payment being equal to a predetermined portion of the prescription price; and

    k) a third payment, made by the prescription benefits manager to the claims processor, the third payment being equal to a predetermined service fee.

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