Prescription benefits network mechanism

• US 20050187793A1
• Filed: 02/11/2005
• Published: 08/25/2005
• Est. Priority Date: 02/23/2004
• Status: Abandoned Application

• Current Assignee: Mapacs-Qahacs & 505 (B) (C), LLC
• Original Assignee: Mapacs-Qahacs & 505 (B) (C), LLC
• Inventors: Myles, Kennith
• Application Number:
  US11/057,294
• Publication Number:
  US 20050187793A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 99/00 Subject matter not provided for in other groups of this subclass
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

A method and apparatus for managing medical costs including prescription medicines is disclosed. A variety of cost-saving mechanisms are contemplated, which will be provided to purchasers via a specialized magnetic card.

Claims

1. A prescription benefits enterprise, comprising:

a centralized computer and operations center which simultaneously communicates with pharmacies, pharmaceutical companies, local health departments, state and local governments, Medicare and Medicaid providers, and participating doctor'"'"'s offices, in order to facilitate the flow of prescription medicines and medical services to purchasers of a pre-paid medical benefits card;

wherein said card is formatted to manage and update data regarding the specific medicines and medical services that have been received by a holder of said card; and

further wherein said centralized computer and operations center debits costs for medical services from said card and credits payments made to said card.

2. The enterprise of claim 1, further comprising:

a first network of providers and services, wherein said participants provide a first level of medicines and medical services.

3. The enterprise of claim 2, further comprising:

a second network of providers and services, wherein said participants provide a second level of medicines and medical services that encompasses but also extends beyond said first level.

4. The enterprise of claim 3, further comprising:

a third network of providers and services, wherein said participants provide a third level of medicines and medical services that encompasses but also extends beyond said second level.

5. The enterprise of claim 4, further comprising:

said providers perform medical trials and studies including pediatric trials in combination with cost reductions mandated under FDA 505(B)(2).

6. The enterprise of claim 1, further comprising:

said centralized computer and operations center having a means for calculating a face value of a medicine or service to be deducted from an account of a cardholder, wherein said means for calculating includes a variety of dispense-as-written values.

7. The enterprise of claim 6, wherein said face value is calculated using a flat dollar percentage amount.

8. The enterprise of claim 6, wherein said face value is calculated using a prepaid percentage amount.

9. The enterprise of claim 6, wherein said face value is calculated using a full difference/dollar amount which disregards dispense-as-written instructions.

10. The enterprise of claim 6, wherein said face value is calculated using a full difference percentage which disregards dispense-as-written instructions.

11. The enterprise of claim 6, wherein said face value is calculated using a percentage plus amount instructions.

12. The enterprise of claim 6, wherein said face value is calculated using an amount with multi-source percentage instructions.

13. The enterprise of claim 6, wherein said face value is calculated using a percentage plus ingredient cost plus professional fees plus full difference instructions.

14. The enterprise of claim 6, wherein said face value is directed at diabetics and is calculated using a one Face Value Per Vial of Insulin

15. The enterprise of claim 6, wherein said face value is calculated using split family instructions

16. The enterprise of claim 6, wherein said face value is calculated drug specific flat dollar amount percentage instructions.

17. The enterprise of claim 6, wherein said face value shall be calculated using a generic difference dollar and dispense-as-written days supply instructions.

18. The enterprise of claim 6, wherein said face value shall be calculated using either medicare or non-medicare or flat dollar amount or percentage instructions.

19. The enterprise of claim 6, wherein said face value shall be calculated using a drug-specific paid MAC instructions.

20. The enterprise of claim 1, wherein quantities of said medications are monitored and controlled using a quantity prepaid dispensing program cost control mechanism.

21. The enterprise of claim 1, wherein said costs for medicines are affected by initiatives which are intended to increase the usage of generic formulations.

22. The enterprise of claim 1, wherein said costs for medical services are affected by exclusivities granted to pharmaceutical companies in exchange for increasing their amount of pediatric testing of medicines.

23. The enterprise of claim 1, wherein said costs for medical services are affected by a Florida Medicaid initiative.

24. The enterprise of claim 1, wherein said costs for medical services and medicines are affected by multi-state purchasing pools.

25. The enterprise of claim 1, wherein said costs for medicines are affected by the United State Food and Drug Administration'"'"'s 505(b)(2) initiative.

26. The enterprise of claim 1, wherein said costs for medical services and medicines are affected by medicare forcing recipients to participate in studies as part of receiving coverage.