Method for conducting prescription drug co-payment plans
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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Abstract
A credit card-based prescription benefits plan utilizes an electronic means for telecommunication to rapidly adjudicate prescription claims. The adjudication process includes a third-party claims processor interposed the pharmacy and the patient'"'"'s credit card clearinghouse to ensure that the subscriber receives all benefits available under the plan. The third-party claims processor may also provide patient counseling and advocacy by performing patient-specifie drug regimen reviews to check for potential adverse drug reactions and drug interactions.
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Citations
14 Claims
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1. A method of providing prescription benefits to subscribers under a plan, comprising the steps of:
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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. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14)
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Specification