System and method for determining the cost of a pharmaceutical

• US 20040117323A1
• Filed: 12/11/2002
• Published: 06/17/2004
• Est. Priority Date: 12/11/2002
• Status: Active Grant

• Current Assignee: Medimpact Healthcare Systems Incorporated
• Original Assignee: Rx Options, Inc.
• Inventors: Mindala, James
• Granted Patent: US 8,521,550 B2
• Time in Patent Office: Days
• US Class Current: 705/400
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• CPC Class Codes: G06Q 30/0283 Price estimation or determination
• CPC Class Codes: G16H 20/13 delivered from dispensers

Abstract

A method for calculating a subscriber pharmaceutical cost that incorporates a discount is disclosed that includes receiving the discount from at least one of a pharmaceutical manufacturer and a pharmacy, and determining a subscriber cost that includes the discount, and that reduces the cost of the pharmaceutical to the subscriber at the point of sale.

Claims

1. A method for calculating a pharmaceutical cost, comprising the steps of:

receiving a first discount amount from a pharmaceutical manufacturer at a prescription benefit management (PBM) system for a pharmaceutical;

reducing a discount basis for the pharmaceutical utilizing the received discount amount;

computing a subscriber cost utilizing the reduced discount basis; and

transmitting the discount basis to a pharmaceutical dispenser for computing a subscriber cost.

2. The method of claim 1, wherein the computing is performed at the PBM.

3. The method of claim 1, wherein the computing is performed at a pharmacy.

4. The method of claim 1, wherein the computing is performed by an insurer.

5. The method of claim 1, wherein the computing is performed by an employer.

6. The method of claim 1, wherein the discount basis is an original pharmaceutical cost.

7. The method of claim 1, wherein the discount basis is an average wholesale price.

8. The method of claim 1, wherein the discount basis is the wholesale acquisition cost.

9. The method of claim 1, further comprising updating the discount basis periodically.

10. A method of claim 1, wherein the subscriber cost is computed at a pharmacy.

11. The method of claim 1, wherein the subscriber cost is computed by the insurer.

12. The method of claim 1, wherein the subscriber cost is computed by the employer.

13. The method of claim 1, further comprising:

receiving a pharmacy discount amount from a pharmaceutical dispenser at the PBM; and

reducing the discount basis for the pharmaceutical utilizing the pharmacy discount amount.

14. The method of claim 13, wherein pharmacy discount amounts are received from a plurality of pharmaceutical dispensers.

15. The method of claim 1, wherein the discount is represented by a discount percentage.

16. The method of claim 15, wherein the subscriber cost is determined by multiplying the discount percentage by the discount basis to determine a dollar discount amount.

17. The method of claim 16, further comprising subtracting the dollar discount amount from the discount basis to determine the subscriber cost.

18. The method of claim 1, further comprising identifying at least one of an average wholesale price and a wholesale acquisition cost.

19. The method of claim 18, further comprising identifying the package size of a pharmaceutical.

20. The method of claim 19, further comprising dividing the at least one average wholesale price and wholesale price cost by the package size, and generating at least one of an average wholesale acquisition cost per unit and a wholesale cost per unit.

21. The method of claim 19, further comprising determining an ingredient cost amount, wherein the ingredient cost amount is determined by multiplying the subscriber cost by the package size.

22. The method of claim 1, further comprising determining a co-payment.

23. The method of claim 22, further comprising adding a dispensing fee.

24. The method of claim 23, wherein the co-payment includes the dispensing fee.

25. The method of claim 22, further comprising classifying a pharmaceutical by tiers to generate a classification.

26. The method of claim 25, further comprising determining the co-payment by the classification of the pharmaceutical.

27. The method of claim 22, wherein there are five tiers.

28. The method of claim 27, wherein a first tier includes generic brands.

29. The method of claim 27, wherein a first tier includes primary preferred brands.

30. The method of claim 27, wherein a first tier includes preferred brands.

31. The method of claim 27, wherein a first tier includes selected brands.

32. The method of claim 27, wherein a first tier includes non-covered brands.

33. A computer system embodying the method of claim 1.

34. A computer readable medium on which a program for performing the method of claim 1 is stored.

35. A method for providing a pharmaceutical discount, comprising the steps of:

receiving a pharmaceutical cost amount from a PBM at a pharmacy dispenser system, said pharmaceutical cost amount comprising a discount amount from a manufacturer; and

transmitting the pharmaceutical cost amount to a subscriber.

36. The method of claim 35, wherein the pharmaceutical cost amount further comprises a discount amount from a pharmaceutical manufacturer.

37. A method for providing a pharmaceutical discount, comprising the steps of:

receiving a pharmaceutical cost amount from a PBM at an employer system, said pharmaceutical cost amount comprising a discount amount from a manufacturer; and

transmitting the pharmaceutical cost amount to a subscriber, wherein the pharmaceutical cost amount further comprises a discount amount from a pharmaceutical manufacturer.

38. A system for determining a subscriber pharmaceutical discount cost, comprising:

a pharmacy benefit management system; and

a pharmacy device coupled to the pharmacy benefit management system, wherein pharmaceutical discount data is communicated between the pharmacy benefit management system and the pharmacy device, and wherein the pharmacy benefit management system determines a subscriber pharmaceutical discount cost.

39. The system of claim 38, further comprising:

a manufacturer discount device coupled to the pharmacy benefit management system, wherein manufacturer discount data is communicated between the manufacturer discount device and the pharmacy benefit management system and issued by the pharmacy benefit management system to determine the subscriber pharmaceutical discount cost that includes one hundred percent of the manufacturer discount data.

40. The system of claim 38, further comprising a subscriber device coupled to the pharmaceutical benefit management system, wherein the pharmaceutical benefit management system transmits the subscriber pharmaceutical discount cost to the subscriber device.

41. The system of claim 38, further comprising at least one of a wireless and wireline connection which couples the pharmacy device to the pharmaceutical benefit management system.

42. The system of claim 38, further comprising an employer device coupled to the pharmacy device, wherein the pharmaceutical discount data is communicated between the employer device and the pharmacy device.

43. The system of claim 42, further comprising a subscriber device coupled to the employer device, wherein the employer device transmits the pharmaceutical discount cost to the subscriber device.

44. A software program for computing a pharmaceutical cost, comprising:

receiving a discount amount from a pharmaceutical manufacturer into a database of a PBM system; and

reducing the pharmaceutical cost by the discount amount.

45. The software program of claim 44, wherein the PBM database is stored as a Microsoft Excel spreadsheet.

46. The software program of claim 44, further comprising computing a subscriber cost utilizing the reduced pharmaceutical cost.