Method for providing consumer choice and equalizing pharmacy provider availability in prescription medication dispensing plans

• US 20060184391A1
• Filed: 11/04/2005
• Published: 08/17/2006
• Est. Priority Date: 02/11/2005
• Status: Abandoned Application

• Current Assignee: Medimpact Healthcare Systems Incorporated
• Original Assignee: Medimpact Healthcare Systems Incorporated
• Inventors: Barre, William J., Brown, Dale R.
• Application Number:
  US11/266,885
• Publication Number:
  US 20060184391A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: A61K 8/66 Enzymes
• CPC Class Codes: A61K 8/732 Starch; Amylose; Amylopectin; Derivatives thereof
• CPC Class Codes: A61Q 19/08 Anti-ageing preparations
• CPC Class Codes: G06Q 30/06 Buying, selling or leasing transactions
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

A method is disclosed whereby consumers enrolled in a prescription benefit plan can obtain prescription medication fulfillment at any participating pharmacy of their choice, regardless of whether the fulfillment is by a retail pharmacy or a mail order pharmacy, and whether the quantity of medication prescribed is for administration over a short period (acute care) or a prolonged period (maintenance). The plan of this invention operates by having the plan manager substantially equalize the financial effects of the discounts and services fees allowed to participating pharmacies such that both retail and mail order pharmacies are compensated in a manner which encourages them to accept all consumers and fill all prescriptions. Compensation is preferably adjusted periodically by the manager to retain pharmacy incentives. Consumers obtain choice of pharmacies, plan payers have pleased employees and members and pharmacies obtain income from the entire spectrum of consumers.

Claims

1. A method for broadening persons'"'"' access to pharmacies for fulfillment of prescriptions under prescription benefit plans, which method comprises:

providing a prescription benefit plan managed by a benefit manager and subscribed to by at least one payer, under which a person affiliated with said payer may have a medical prescription filled at any participating pharmacy;

enrolling at least one participating pharmacy in said plan to provide fulfillment of said prescription upon request by said person and approval by said manager;

establishing a market price for a medication dispensed based on such prescription;

establishing a discounted amount of such market price with said discounted amount to be paid by said manager to said pharmacy for fulfillment of said prescription; and

establishing said discounted amount at a level such that participation in said plan is substantially equally attractive to any type of pharmacy;

whereby the choice of said person of which pharmacy to patronize for fulfillment of said prescription is not unduly influenced by financial considerations.

2. A method as in claim 1 wherein said participating pharmacy comprises a retail pharmacy or a mail order pharmacy.

3. A method as in claim 1 further comprising said payer paying to said manager in connection with said fulfillment of said prescription by said pharmacy a reimbursement amount sufficient to cover said discounted amount paid by said manager to said pharmacy.

4. A method as in claim 3 where said payer further pays to said manager an fee for said manager'"'"'s service in managing said plan for fulfillment of said prescription for said person affiliated with said payer.

5. A method as in claim 1 wherein subscription by said payer to said plan is by contract with said manager.

6. A method as in claim 1 wherein enrollment by said pharmacy in said plan is by contract with said manager.

7. A method as in claim 1 wherein said market price for said medication is determined by reference to at least one public market price compilation regarding such medication.

8. A method as in claim 7 wherein said manager selects said public market price compilation on which to base said market price.

9. A method as in claim 8 wherein determination of said market place is determined by said manager by reference to a plurality of said public market price compilations.

10. A method as in claim 1 wherein at least one of said market price and said discounted amount is determined by at least one of the identity of the medication prescribed, the dosage of said medication prescribed and the quantity of dosage units prescribed.

11. A method as in claim 10 wherein determination is based on said quantity of dosage units prescribed.

12. A method as in claim 11 wherein said quantity of dosage units prescribed comprises not more than about one month'"'"'s supply of said medication for said person.

13. A method as in claim 11 wherein said quantity of dosage units prescribed comprises more than about one month'"'"'s supply of said medication for said person.

14. A method as in claim 13 wherein said quantity of dosage units prescribed comprises at least about two months'"'"' supply of said medication for said person.

15. A method for broadening persons'"'"' access to pharmacies for fulfillment of prescriptions under prescription benefit plans, which method comprises:

providing a prescription benefit plan managed by a benefit manager and subscribed to by at least one payer, under which a person affiliated with said payer may have a medical prescription filled at any participating pharmacy;

enrolling at least one participating pharmacy in said plan to provide fulfillment of said prescription upon request by said person and approval by said manager;

establishing a market price for a medication dispensed based on such prescription;

establishing a discounted amount of such market price with said discounted amount to be paid by said manager to said pharmacy for fulfillment of said prescription;

establishing said discounted amount at a level such that participation in said plan is substantially equally attractive to any type of pharmacy;

conducting assessment of said participation of a pharmacy in said plan to determine performance of said pharmacy in comparison with other pharmacies also enrolled in said plan; and

adjusting said discounted amount paid to said pharmacy periodically in response to said assessment of said performance to provide incentive for good performance;

whereby the choice of said person of which pharmacy to patronize for fulfillment of said prescription is not unduly influenced by financial considerations and pharmacies enrolled are given incentive to provide good service to said person.

16. A method as in claim 15 wherein said participating pharmacy comprises a retail pharmacy or a mail order pharmacy.

17. A method as in claim 15 wherein adjusting said discounted amount in response to said assessment comprises truing up said discounted amount.

18. A method as in claim 17 wherein truing up said discounted amount comprises increasing said discounted amount for a pharmacy which has exceeded performance expectations during an assessment period and decreasing said discounted amount for a pharmacy which has fallen short of performance expectations during an assessment period.

19. A method as in claim 17 wherein said truing up is conducted periodically.

20. A method as in claim 15 further comprising said payer paying to said manager in connection with said fulfillment of said prescription by said pharmacy a reimbursement amount sufficient to cover said discounted amount paid by said manager to said pharmacy.

21. A method as in claim 20 where said payer further pays to said manager an fee for said manager'"'"'s service in managing said plan for fulfillment of said prescription for said person affiliated with said payer.

22. A method as in claim 15 wherein subscription by said payer to said plan is by contract with said manager.

23. A method as in claim 15 wherein enrollment by said pharmacy in said plan is by contract with said manager.

24. A method as in claim 15 wherein said market price for said medication is determined by reference to at least one public market price compilation regarding such medication.

25. A method as in claim 24 wherein said manager selects said public market price compilation on which to base said market price.

26. A method as in claim 25 wherein determination of said market place is determined by said manager by reference to a plurality of said public market price compilations.

27. A method as in claim 15 wherein at least one of said market price and said discounted amount is determined by at least one of the identity of the medication prescribed, the dosage of said medication prescribed and the quantity of dosage units prescribed.

28. A method as in claim 27 wherein determination is based on said quantity of dosage units prescribed.

29. A method as in claim 28 wherein said quantity of dosage units prescribed comprises not more than about one month'"'"'s supply of said medication for said person.

30. A method as in claim 28 wherein said quantity of dosage units prescribed comprises more than about one month'"'"'s supply of said medication for said person.

31. A method as in claim 30 wherein said quantity of dosage units prescribed comprises at least about two months'"'"' supply of said medication for said person.

32. A method for broadening persons'"'"' access to pharmacies for fulfillment of prescriptions under prescription benefit plans, which method comprises:

providing a prescription benefit plan managed by a benefit manager and subscribed to by at least one payer, under which a person affiliated with said payer may have a medical prescription filled at any pharmacy;

enrolling at least one pharmacy in said plan to provide fulfillment of said prescription upon request by said person and approval by said manager;

conducting assessment of said participation of a pharmacy in said plan to determine performance of said pharmacy in comparison with other pharmacies also enrolled in said plan; and

adjusting reimbursement paid to said pharmacy periodically in response to said assessment of said performance to provide incentive for good performance;

whereby the choice of said person of which pharmacy to patronize for fulfillment of said prescription is not unduly influenced by financial considerations and pharmacies enrolled are given incentive to provide good service to said person.

33. A method as in claim 32 wherein said participating pharmacy comprises a retail pharmacy or a mail order pharmacy.

34. A method as in claim 32 wherein adjusting said discounted amount in response to said assessment comprises truing up said discounted amount.

35. A method as in claim 34 wherein truing up said discounted amount comprises increasing said discounted amount for a pharmacy which has exceeded performance expectations during an assessment period and decreasing said discounted amount for a pharmacy which has fallen short of performance expectations during an assessment period.

36. A method as in claim 34 wherein said truing up is conducted periodically.

37. A method as in claim 32 wherein said assessment is conducted periodically.

38. A method as in claim 32 further comprising said payer paying to said manager in connection with said fulfillment of said prescription by said pharmacy an amount sufficient to cover said reimbursement paid by said manager to said pharmacy.

39. A method as in claim 38 where said payer further pays to said manager an fee for said manager'"'"'s service in managing said plan for fulfillment of said prescription for said person affiliated with said payer.

40. A method as in claim 32 wherein subscription by said payer to said plan is by contract with said manager.

41. A method as in claim 32 wherein enrollment by said pharmacy in said plan is by contract with said manager.

42. A method as in claim 32 wherein said reimbursement for said medication is determined by reference to at least one public market price compilation regarding such medication.

43. A method as in claim 42 wherein said manager selects said public market price compilation on which to base said reimbursement.

44. A method as in claim 42 wherein determination of said reimbursement is determined by said manager by reference to a plurality of said public market price compilations.

45. A method as in claim 32 wherein said reimbursement is determined by at least one of the identity of the medication prescribed, the dosage of said medication prescribed and the quantity of dosage units prescribed.

46. A method as in claim 45 wherein determination is based on said quantity of dosage units prescribed.

47. A method as in claim 46 wherein said quantity of dosage units prescribed comprises not more than about one month'"'"'s supply of said medication for said person.

48. A method as in claim 46 wherein said quantity of dosage units prescribed comprises more than about one month'"'"'s supply of said medication for said person.

49. A method as in claim 47 wherein said quantity of dosage units prescribed comprises at least about two months'"'"' supply of said medication for said person.