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Apparatus and method for managing prescription benefits

  • US 20070082543A1
  • Filed: 12/07/2006
  • Published: 04/12/2007
  • Est. Priority Date: 01/22/2002
  • Status: Active Grant
First Claim
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1. :

  • A method of managing prescription benefits offered by a plurality of providers comprising;

    storing prescription benefit case records in a prescription benefits management system for patients receiving prescription benefits coverage for the plurality of healthcare providers, said prescription benefit case records containing information regarding the patients and prescription coverage activities for the patient;

    providing access to said prescription benefits management system by the plurality of providers of prescription benefits over one or more electronic communication networks;

    accessing by a user said prescription benefits management system from remote locations via one or more electronic communication networks;

    conducting an inquiry on said prescription benefit case records to view and reviewing selected prescription coverage activities contained in said prescription benefit case records, inputting additional prescription coverage activities into said case records, if necessary, verifying that said case records have been updated, if additional prescription coverage activities will not be inputted, displaying an activity report containing all prescription coverage activities and reference data for the prescription benefit case record, displaying coverage activity details for the selected prescription benefit case record, the coverage activity details including at least a list of prescription products, a list of coverage prescription products, and a list of prescription product categories, displaying one or more reasons for each prescription coverage denial, and reviewing details of the displayed reasons, and at least one of overriding the displayed prescription coverage denial based on one or more clinical and prescription criteria, replacing an original prescription product with a substitute prescription product that is covered by a prescription benefit plan associated with the case record, and appealing the prescription coverage denial based on clinical reasons in response to receiving a request from a user, accessing a new prescription benefit case record for prescription benefits currently being viewed by a second user, releasing the new prescription case record without the second user'"'"'s authorization, modifying information contained in the prescription benefit case record, and closing said prescription benefit case records.

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