System and method for clinical strategy for therapeutic pharmacies

• US 20070214009A1
• Filed: 10/04/2006
• Published: 09/13/2007
• Est. Priority Date: 10/05/2005
• Status: Active Grant

• Current Assignee: Express Scripts Strategic Development, Inc. (The Cigna Group)
• Original Assignee: Medco Health Solutions Incorporated (The Cigna Group)
• Inventors: Anand, Tej, Epstein, Robert, Proulx, Mark, Anderson, Roger, Klepper, Kenneth
• Granted Patent: US 7,711,583 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 20/13 delivered from dispensers
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16H 50/70 for mining of medical data, e.g. analysing previous cases of other patients
• CPC Class Codes: G16H 70/60 relating to pathologies
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

A system and method of distributing pharmaceutical prescriptions within a network of pharmacies based review of prescription claim data and patient medical state to enable stratification of patients, wherein each pharmacy within the network has been established to handle one or more particular patient medical states.

Claims

1. A method for routing a pharmaceutical prescription to a therapeutic pharmacy within a network of therapeutic pharmacies, wherein the method is suitable for selecting a therapeutic pharmacy for filling the prescription based upon patient medical records and prescription claims, comprising the steps of:

a. means for receiving a pharmaceutical prescription for a patient at a pharmacy intake center;

b. retrieving medical records and prescription claims for the patient from an information warehouse;

c. analyzing the medical records and prescription claims to stratify the patient into a disease category;

d. establishing a network of therapeutic pharmacies, wherein each therapeutic pharmacy within the network is established in accordance with a wellness category;

e. classifying the patient prescription to the patient wellness category, and routing a pharmaceutical prescription to a therapeutic pharmacy within a network; and

f. filling and dispensing the prescription to the patient.

2. The method according to claim 1, wherein means for receiving a prescription are selected from telephonic, mail, hand, and electronic delivery.

3. The method according to claim 2, wherein the electronic delivery is by way of the Internet.

4. The method according to claim 1, wherein retrieving medical records and prescription claims comprise gathering available prescription claims and medical records of a patient within a data repository.

5. The method according to claim 1, wherein analyzing medical records and prescription claims comprises determining particular diseases category and assigning a patient to a disease category.

6. The method according to claim 5, wherein the disease category consist of neurology/psychiatry, pulmonary, cardiovascular, diabetes, gastroenterology, oncology/hematology, rare diseases, pediatrics and combinations thereof.

7. The method according to claim 5, wherein the disease category of neurology/psychiatry consists of pain, insomnia, depression, seizures, and combinations thereof.

8. The method according to claim 5, wherein the disease category of pulmonary consists of cystic fibrosis, COPD, asthma, pediatric and combinations thereof.

9. The method according to claim 5, wherein the disease category of cardiovascular consists of coagulation disorders, coronary diseases, hyperlipidemia, hypertension and combinations thereof.

10. The method according to claim 5, wherein the disease category of diabetes consists of type I, type II, pediatric, metabolic syndrome and combinations thereof.

11. The method according to claim 5, wherein the disease category of gastroenterology consists of GERD, peptic ulcer disease, inflammatory bowel diseases, irritable bowel syndrome and combinations thereof.

12. The method according to claim 5, wherein the disease category of oncology/hematology consists of common cancers, anemia, transplants, blood diseases, and combinations thereof.

13. The method according to claim 5, wherein the disease category of rare diseases consists of pulmonary hypertension, hemophilia, Gaucher'"'"'s Disease and combinations thereof.

14. The method according to claim 1, wherein the network of therapeutic pharmacies consist of individual pharmacies for neurology/psychiatry, pulmonary, cardiovascular, diabetes, gastroenterology, oncology/hematology, rare diseases and combinations thereof.

15. The method according to claim 1, wherein the wellness categories consist of well, acute, chronic, and complex.

16. The method according to claim 1, wherein routing a prescription consists of correlating the disease category with the pharmacy established to fill prescriptions for the disease category, assigning the prescription to that pharmacy, and filling and dispensing the prescription.

17. A system for routing a pharmaceutical prescription to a therapeutic pharmacy within a network of therapeutic pharmacies, wherein the system is suitable for selecting a therapeutic pharmacy for filling the prescription based upon patient medical records and prescription claims, comprising:

a. a plurality of individual therapeutic pharmacies within a network of therapeutic pharmacies, wherein the individual pharmacies are established to receive prescriptions for one or more diseases, wherein the diseases are selected from the group consisting of neurology/psychiatry, pulmonary, cardiovascular, diabetes, gastroenterology, oncology/hematology, rare diseases, pediatrics and combinations thereof;

b. a plurality of pharmacist in the individual pharmacies able to resolve protocol, perform drug utilization review, and fill and dispense prescriptions for one or more diseases, wherein the diseases are selected from the group consisting of neurology/psychiatry, pulmonary, cardiovascular, diabetes, gastroenterology, oncology/hematology, rare diseases and combinations thereof;

c. an information warehouse containing patient prescription claims and medical records;

d. a patient stratification/classification unit in communication with the information warehouse, wherein the stratification/classification system is suitable for retrieving prescription claims and medical records from the information warehouse, and classifying a patient into a disease state;

e. a clinical score unit in communication with the information warehouse a patient stratification/classification unit suitable for retrieving information from the information warehouse and assigning a score to a patient based upon a degree of wellness;

f. a patient on-line authoritative record unit in communication with the patient stratification/classification and clinical score units, wherein patient on-line authoritative record unit receives stratification and score information;

g. a rules-based unit comprising patient health insurance and formulary information, wherein the rules-based unit is in communication with and provides insurance coverage information to the patient on-line authoritative record unit;

h. a prescription receiving unit suitable for receiving prescription and refill orders for the system, requesting patient stratification, clinical score and coverage rules from patient on-line authoritative record unit; and

i. an optimal workflow and load-balancing unit capable of receiving combined prescription-stratification-score information from the prescription receiving unit and assigning the combined prescription-stratification-score information to a suitable pharmacy within the network for filling and dispensing prescriptive medication.

18. The system according to claim 17, wherein an integrated contact management unit in electronic communication with the optimal workflow and load-balancing unit, the therapeutic pharmacies, and the patient on-line authoritative record unit, wherein the integrated contact management unit is suitable for receiving the combined prescription-stratification-score information from the optimal workflow and load-balancing unit and resolving prescription protocols prior to forwarding the prescription the individual therapeutic pharmacy.