PHARMACEUTICAL CLEARINGHOUSE METHOD AND SYSTEM

• US 20070233517A1
• Filed: 03/28/2007
• Published: 10/04/2007
• Est. Priority Date: 03/31/2006
• Status: Active Grant

• Current Assignee: Sandeep Dayal
• Original Assignee: Sandeep Dayal
• Inventors: Dayal, Sandeep
• Granted Patent: US 8,086,469 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

A pharmaceutical clearinghouse establishes relationships with a set of foundations and a set of pharmaceutical providers; in response to the clearinghouse receiving a patient request for a pharmaceutical from a foundation, the clearinghouse obtains a subsidy from at least one provider and directs the subsidy to the foundation. The subsidy can be cash, in-kind drug, or a combination thereof.

Claims

1. A method of independently providing pharmaceutical subsidies from pharmaceutical providers to foundations comprising one or more steps configured to be carried out by at least one computer system, the method comprising:

providing a clearinghouse that maintains independence between a network of foundations and a network of pharmaceutical providers, wherein

the network of foundations is configured to submit patient requests for drugs to the clearinghouse, and

the network of pharmaceutical providers is configured to provide subsidies in a form including cash, in-kind drug, or a combination thereof to satisfy the patient requests; and

upon receipt of a patient request for a drug from a foundation from the network of foundations, the clearinghouse determining a subsidy to be provided by one or more of the network of pharmaceutical providers to obtain the drug and the clearinghouse directing the subsidy to the foundation.

2. The method of claim 1, further comprising:

determining if the drug is available from a pharmaceutical provider in the network of pharmaceutical providers.

3. The method of claim 2, wherein if the drug is available from the pharmaceutical provider the method including:

the pharmaceutical provider providing the subsidy in the form of only in-kind drug.

4. The method of claim 2, wherein if the drug is available from the pharmaceutical provider the method including:

the pharmaceutical provider providing the subsidy in the form of in-kind drug and cash.

5. The method of claim 2, wherein if the drug is available from the pharmaceutical provider the method including:

establishing a fair market value of the drug by the pharmaceutical provider providing at least a portion of the subsidy in the form of cash and procuring the drug on the open market with the cash.

6. The method of claim 1, wherein if the drug is not available from any pharmaceutical provider in the network of pharmaceutical providers, the method including:

determining an amount needed to procure the drug; and

determining a cash portion of the amount to be paid by one or more of the pharmaceutical providers in the network of pharmaceutical providers.

7. The method of claim 6, wherein determining the cash portion includes determining a pro rata portion to be paid by each of the one or more pharmaceutical providers, including determining the pro rata portion as a function of the total amount of all subsidies provided by the network of pharmaceutical providers.

8. The method of claim 1, including:

the patient submitting a single application and a plurality of foundations competing to provide obtain the subsidy and provide the drug to the patient.

9. The method of claim 1, further comprising:

establishing a low-cost pharmaceutical provider threshold, whereby pharmaceutical providers that provide drugs that cost less than the low-cost threshold do not subsidize pharmaceutical providers having drugs that cost more than the low cost threshold.

10. The method of claim 1, further comprising:

establishing a low-cost pharmaceutical provider threshold, whereby pharmaceutical providers that provide drugs that cost less than the low-cost threshold provide subsidies in a smaller proportion than pharmaceutical providers having drugs that cost more than the low cost threshold.

11. The method of claim 1, wherein comprising:

using a uniform and auditable standard of patient need assessment to determine eligibility for and the amount of subsidy.

12. The method of claim 1, further including:

providing the subsidy in the form of one or more coupon that can be applied against the drug costs and patient co-pay for any drug in a given disease state.

13. A pharmaceutical clearinghouse system, configured to independently provide pharmaceutical subsidies from pharmaceutical providers to foundations, the system comprising:

a clearinghouse configured to maintain independence between a network of foundations and a network of pharmaceutical providers, wherein

the network of foundations is configured to submit patient requests for drugs to the clearinghouse, and

the network of pharmaceutical providers is configured to provide subsidies in a form including cash, in-kind drug, or a combination thereof to satisfy the patient requests; and

a set of subsidy modules configured, upon receipt of a patient request for a drug from a foundation from the network of foundations, to determine a subsidy to be provided by one or more of the network of pharmaceutical providers to obtain the drug and to direct the subsidy to the foundation.

14. The system of claim 13, further comprising:

an intake processor configured to determine if the foundation is in the network of foundations.

15. The system of claim 13, wherein the set of subsidy modules is configured to determine if the drug is available from a pharmaceutical provider from the network of pharmaceutical providers and, if so, to request the subsidy from the pharmaceutical provider in the form of only in-kind drug.

16. The system of claim 13, wherein the set of subsidy modules is configured to determine if the drug is available from a pharmaceutical provider from the network of pharmaceutical providers and, if so, to request the subsidy from the pharmaceutical provider in the form of only in-kind drug and cash.

17. The system of claim 13, wherein the set of subsidy modules is configured to determine if the drug is available from a pharmaceutical provider from the network of pharmaceutical providers and, if so, to establish a fair market value of the drug by requesting the pharmaceutical provider to provide at least a portion of the subsidy in the form of cash to enable procurement of the drug on the open market with the cash.

18. The system of claim 13, wherein the set of subsidy modules is configured to determine if the drug is available from a pharmaceutical provider from the network of pharmaceutical providers and, if not, to:

determine an amount needed to procure the drug; and

determine a cash portion of the amount to be paid by one or more of the pharmaceutical providers in the network of pharmaceutical providers.

19. The system of claim 18, wherein the set of subsidy modules is configured to determine a pro rata portion of the cash portion to be paid by each of the one or more pharmaceutical providers, as a function of the total amount of all subsidies provided by the network of pharmaceutical providers.

20. The system of claim 13, wherein the clearinghouse is configured to enable a plurality of foundations to compete to obtain the subsidy and provide the drug to the patient based on a single patient request.

21. The system of claim 13, wherein the clearinghouse is configured to establish a low-cost pharmaceutical provider threshold, and the set of subsidy modules is configured to determine the subsidies such that pharmaceutical providers that provide drugs that cost less than the low-cost threshold do not subsidize pharmaceutical providers having drugs that cost more than the low cost threshold.

22. The system of claim 13, wherein the clearinghouse is configured to establish a low-cost pharmaceutical provider threshold, and the set of subsidy modules is configured to determine the subsidies such that pharmaceutical providers that provide drugs that cost less than the low-cost threshold provide subsidies in a smaller proportion than pharmaceutical providers having drugs that cost more than the low cost threshold.

23. The system of claim 13, wherein the clearinghouse is configured to establish a uniform and auditable standard of patient need assessment to determine eligibility for and the amount of subsidy.

24. The system of claim 13, wherein the clearinghouse is configured to provide the subsidy in the form of one or more coupons that can be applied against the drug costs and patient co-pay for any drug in a given disease state.