Method and system for aggregating multiple prescription claims

• US 20060020514A1
• Filed: 07/22/2005
• Published: 01/26/2006
• Est. Priority Date: 07/23/2004
• Status: Abandoned Application

• Current Assignee: Rx Patent Incorporated
• Original Assignee: Rx Patent Incorporated
• Inventors: Yered, Paul
• Application Number:
  US11/187,547
• Publication Number:
  US 20060020514A1
• Time in Patent Office: Days
• US Class Current: 705/14.270
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/0226 Incentive systems for frequent usage, e.g. frequent flyer miles programs or point systems
• CPC Class Codes: G06Q 30/0234 Rebates after completed purchase
• CPC Class Codes: G06Q 30/0601 Electronic shopping [e-shopping]

Abstract

A system for reducing prescription costs includes a claims processing subsystem that receives and process prescription claims from pharmacies and/or employers and/or other parties or entities, who unify their prescription claims. The prescriptions claims are for drugs made by multiple manufacturers. The received claims are aggregated and sorted by manufacturer. Manufacturer rebates are received from each manufacturer, based on the aggregated claims for that manufacturer. The manufacturer rebates are allocated and distributed to each party or entity, based on the portion of the manufacturer rebates that are attributable to the claims that are received from that party or entity.

Claims

1. A system for reducing prescription costs, the system comprising:

a processing system configured to receive and process claims from multiple pharmacies for prescriptions made by multiple manufacturers, the processing system further configured to aggregate the received claims for the prescriptions made by each manufacturer, to obtain from each manufacturer a manufacturer rebate based on the aggregated claims for that manufacturer, and to allocate and distribute a pharmacy rebate to each pharmacy, each pharmacy rebate being based on the portion of the manufacturer rebates that is attributable to the claims that are received from the pharmacy.

2. The system of claim 1,

further comprising a data storage subsystem;

and

wherein the processing system is configured to store the received claims in the data storage subsystem.

3. The system of claim 1, wherein at least some of the claims received by the processing system comprise claims submitted by or on behalf of one or more parties, and wherein the processing system is further configured to allocate and distribute a rebate to each of the parties, the rebate for each party being based on the portion of the manufacturer rebates that is attributable to the claims submitted by or on behalf of that party.

4. The system of claim 3,

wherein the parties comprise at least one of:

an employee of an employer;

a non-insured consumer;

an insured consumer;

a non-prescription insured customer;

a patient;

and

a subscriber to a policy.

5. The system of claim 4,

wherein the rebate distributed to at least some of the parties comprises one or more of:

a pharmacy coupon;

a pharmacy credit;

a pharmacy cash refund;

a non-pharmacy store coupon;

pharmacy points or miles;

airline miles; and

club card credits.

6. The system of claim 1, wherein the processing system is further configured to distribute the pharmacy rebate by an electronic transfer of funds.

7. The system of claim 1, wherein the processing system is further configured to obtain a manufacturer rebate by delivering a request to each manufacturer for a manufacturer rebate based on the aggregated claims for that manufacturer, and by receiving a manufacturer rebate from each manufacturer in response to the request to the manufacturer.

8. The system of claim 3, further comprising a reporting subsystem configured to post on a website information about the pharmacy rebate or about the rebate distributed to each party.

9. The system of claim 8, wherein the reporting subsystem is further configured to receive a request at the website from one of the pharmacies about the pharmacy rebate that is delivered to that pharmacy and to provide, in response to the request, information from the website to that pharmacy about the pharmacy rebate that is delivered to that pharmacy;

and

wherein the reporting subsystem is further configured to receive a request at the website from one of the parties about the rebate that is delivered to that party and to provide, in response to the request, information from the website to that party about the rebate that is delivered to that party.

10. The system of claim 8, wherein the reporting subsystem is further configured to deliver periodic statements to each of the pharmacies about the pharmacy rebate that is delivered to that pharmacy, and to delivery periodic statements to each of the parties about the rebate that is delivered to that party.

11. The system of claim 2, wherein the processing system comprises:

a rebate aggregator configured to aggregate the claims in the data storage subsystem for the prescriptions made by each manufacturer; and

a rebate administrator configured to deliver a request to each manufacturer for a manufacturer rebate based on the aggregated claims for that manufacturer, to receive a manufacturer rebate from each manufacturer in response to the request to the manufacturer, and to allocate and distribute a pharmacy rebate to each pharmacy, each pharmacy rebate based on the portion of the manufacturer rebates that are attributable to the claims that are received from that pharmacy.

12. A system for reducing prescription costs, the system comprising:

a processing subsystem configured to receive and process, on behalf of multiple employers, claims from multiple pharmacies for prescriptions made by multiple manufacturers, the processing system further configured to aggregate the received claims for the prescriptions made by each manufacturer, to obtain from each manufacturer a manufacturer rebate based on the aggregated claims for that manufacturer, and to distribute a rebate to each employer,

wherein each rebate is allocated based on the portion of the manufacturer rebates that is attributable to the claims that are received on behalf of that employer.

13. The system of claim 12, wherein each employer has one or more employees, and wherein the processing system is further configured to allocate and distribute a rebate to each of the employees, the rebate distributed to each employee being based on the portion of the manufacturer rebates that is attributable to the claims that originate from that employee.

14. The system of claim 13, wherein the rebate distributed to at least some of the employees comprises at least one of:

an increase in wages;

one or more days off;

a paid vacation;

free merchandise;

an airline ticket;

a lower pharmacy co-pay; and

a lower deductible.

15. A system for reducing prescription costs, the system comprising:

means for receiving claims from multiple pharmacies for prescriptions made by multiple manufacturers;

means for storing the received claims;

means for aggregating the claims in the database for the prescriptions made by each manufacturer;

means for obtaining a manufacturer rebate from each manufacturer based on the aggregated claims for that manufacturer;

means for allocating and distributing a pharmacy rebate to each of the pharmacies, each pharmacy rebate based on the portion of the manufacturer rebates that are attributable to the claims that are received from the pharmacy.

16. A system for reducing prescription costs, the system comprising:

a claims processing subsystem configured to receive and process claim information about a first set of claims from multiple pharmacies and about a second set of claims from multiple pharmacies, wherein the first set of claims are for prescriptions made by multiple manufacturers including at least one claim for a prescription made by a first manufacturer, and have been previously received by a first claims processing organization, and wherein the second set of claims are for prescriptions made by multiple manufacturers including at least one claim for a prescription made by the first manufacturer, and have been previously received by a second claims processing organization, the claims processing subsystem comprising;

a rebate subsystem configured to aggregate the claim information for the prescriptions made by each manufacturer, to obtain from each manufacturer a manufacturer rebate based on the aggregated claim information for that manufacturer, and to allocate and distribute a rebate in connection with each of the claims, based on the portion of the manufacturer rebates that is attributable to the claim.

17. The system of claim 16, wherein the claims processing subsystem is configured to receive the claim information from a third claims processing organization.

18. The system of claim 16, wherein at least one of the first and second claims processing organizations comprises a prescription benefit manager.

19. A method of reducing prescription costs, comprising:

receiving claims from multiple pharmacies for prescriptions made by multiple manufacturers;

aggregating the received claims for the prescriptions made by each manufacturer;

obtaining a manufacturer rebate from each manufacturer, based on the aggregated claims for that manufacturer; and

allocating and distributing a pharmacy rebate to each of the pharmacies, each pharmacy rebate being based on the portion of the manufacturer rebates that are attributable to the claims that are received from the pharmacy.

20. The method of claim 19,

wherein the act of receiving the claims from multiple pharmacies comprises the act of receiving at least some claims that originate from one or more parties, and

further comprising the act of allocating and distributing a rebate to each of the parties, based on the percentage of the manufacturer rebates that are attributable to the claims that originate from that party.

21. The method of claim 20,

wherein the parties comprise at least one of:

an employee of an employer;

a non-insured consumer;

an insured consumer;

a non-prescription insured customer;

a patient;

an employer;

and

a subscriber to a policy.

22. A system for reducing prescription costs, the system comprising:

a processing system configured to receive and process claims from multiple pharmacies for prescriptions made by multiple manufacturers, the processing system further configured to aggregate the received claims for the prescriptions made by each manufacturer, to obtain from each manufacturer a manufacturer rebate based on the aggregated claims for that manufacturer, and to allocate and distribute a pharmacy rebate to each pharmacy, each pharmacy rebate being based on a portion of the manufacturer rebates.

23. A system for reducing prescription costs, the system comprising:

a processing system configured to receive and process claims from multiple parties for prescriptions made by multiple manufacturers, the processing system further configured to aggregate the received claims for the prescriptions made by each manufacturer, to obtain from each manufacturer a manufacturer rebate based on the aggregated claims for that manufacturer, and to allocate and distribute a rebate to each party, each rebate being based on a portion of the manufacturer rebates.

24. The system of claim 23,

wherein the parties comprise at least one of:

an employee of an employer;

a non-insured consumer;

an insured consumer;

a non-prescription insured customer;

a patient;

an employer;

and

a subscriber to a policy.

25. The system of claim 23, wherein each rebate distributed to each party is based on the portion of the manufacturer rebates that is attributable to the claims that are received from that party.