VIRTUAL INVENTORY SYSTEM AND METHODS FOR COVERED ENTITIES

• US 20090319293A1
• Filed: 06/23/2008
• Published: 12/24/2009
• Est. Priority Date: 06/23/2008
• Status: Abandoned Application

• Current Assignee: American Health Care
• Original Assignee: American Health Care
• Inventors: Valerio, David A., Lee, Grover C.
• Application Number:
  US12/144,546
• Publication Number:
  US 20090319293A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

A virtual transaction process and system providing a mechanism for a covered entity to maintain a virtual inventory with a contracted pharmacy for dispensing medication for the covered entity'"'"'s employees. An administrative entity is provided that adjudicates claims with the contracted pharmacy, and compiles a utilization report for the prescription medication manufacturer and covered entity to effect a chargeback credit from the manufacturer and payment between the covered entity and contracted pharmacy.

Claims

1. A method of dispensing a prescription for a covered entity, comprising:

providing a contracting pharmacy having inventory to fill prescriptions for a covered entity;

receiving a transmission from the contracting pharmacy, the transmission comprising a prescription pharmaceutical claim;

adjudicating the pharmaceutical claim;

transmitting the adjudicated claim back to the contracting pharmacy;

compiling a utilization report for the pharmaceutical claim;

sending the utilization report to a pharmaceutical manufacturer for payment of a chargeback credit; and

sending the utilization report to the covered entity for payment of contract pharmaceutical price plus administrative fees.

2. A method as recited in claim 1, further comprising:

receiving the chargeback credit from manufacturer and payment from covered entity; and

issuing payment to the contracted pharmacy.

3. A method as recited in claim 2, wherein the payment issued to the contracted pharmacy comprises the WAC prescription cost plus a pharmacy dispensing fee, less any co-pay collected by the contracted pharmacy.

4. A method as recited in claim 1, further comprising:

facilitating payment of the chargeback credit and contract pharmaceutical price to the contracted pharmacy; and

receiving an administrative fee from the covered entity.

5. A method as recited in claim 1, wherein adjudicating the claim comprises:

verifying client eligibility;

verifying of claim data validity; and

determining co-pay amount.

6. A method as recited in claim 5, wherein the pharmaceutical claim is transmitted with an NDC.

7. A method as recited in claim 6, wherein the pharmaceutical claim is adjudicated by comparing the transmitted claim against one or more databases of stored NDC codes.

8. A method as recited in claim 6, wherein the utilization report is generated according to the covered entity, the contracted pharmacy, patient, and NDC.

9. A method as recited in claim 1, wherein providing a contracting pharmacy comprises:

providing an administrative entity in communication with the covered entity, at least one contracting pharmacy, and at least one pharmaceutical manufacturer; and

facilitating an agreement via the administrative entity between the covered entity and at least one contracting pharmacy for dispensing prescriptions for the covered entity.

10. A method as recited in claim 9, wherein the administrative entity adjudicates the pharmaceutical claim and compiles and sends the utilization report for the pharmaceutical claim to the manufacturer and covered entity.

11. A method of dispensing a medication for a covered entity, comprising:

providing an administrative entity in communication with the covered entity, at least one contracting pharmacy, and at least one pharmaceutical manufacturer;

arranging for at least one contracting pharmacy to dispense medication for the covered entity;

receiving a transmission from the contracting pharmacy to the administrative entity, the transmission comprising a prescription claim for a medication;

adjudicating the prescription claim;

transmitting the adjudicated claim back to the contracting pharmacy; and

compiling a utilization report for the prescription claim for payment of a chargeback credit from a manufacturer of the medication and reimbursement from the covered entity to the contracting pharmacy.

12. A method as recited in claim 11, further comprising:

sending the utilization report to the medication manufacturer for payment of a chargeback credit; and

sending the utilization report to the covered entity for payment of contract medication price plus administrative fees.

13. A method as recited in claim 11, further comprising:

receiving the chargeback credit from manufacturer and payment from covered entity; and

issuing payment to contracted pharmacy.

14. A method as recited in claim 13, wherein the payment issued to the contracted pharmacy comprises the WAC prescription cost plus a pharmacy dispensing fee, less any co-pay collected by the contracted pharmacy.

15. A method as recited in claim 11, further comprising:

facilitating payment of the chargeback credit and contract medication price to the contracted pharmacy via the administrative entity; and

receiving an administrative fee from the covered entity.

16. A method as recited in claim 11, wherein adjudicating the claim comprises:

verifying client eligibility;

verifying of claim data validity; and

determining co-pay amount.

17. A method as recited in claim 16, wherein the claim is transmitted to and from the administrative entity with an NDC.

19. A method as recited in claim 11:

wherein the utilization report is sent to the covered entity for payment of contract medication price plus administrative fees;

wherein the covered entity facilitates payment of chargeback credit via a wholesaler.

18. A method as recited in claim 18, wherein the claim is adjudicated by comparing the transmitted claim against one or more databases of stored NDC codes;

said databases being maintained by the administrative entity.

20. A virtual inventory system for dispensing a prescription medication for a covered entity, comprising:

a communication link coupled to the covered entity, one or more medication manufacturers, and one or more contracting pharmacies;

a processor coupled to the communication link;

the processor configured to adjudicate a prescription medication claim transmitted from a contracting pharmacy to facilitate dispensing of the prescription medication at the contracting pharmacy;

the processor further configured to compile a utilization report for the prescription medication claim; and

one or more databases coupled to the processor, the databases comprising data used in adjudicating the claim and compiling a utilization report;

utilization report facilitating a payment of a chargeback credit from the manufacturer of the prescription medication and payment of a contract prescription price plus administrative fees from the covered entity to the contracting pharmacy.

21. A system as recited in claim 20:

wherein the one or more databases comprise lists of NDC codes;

wherein the processor adjudicates the pharmaceutical claim by comparing the transmitted claim against one or more databases of stored NDC codes.

22. A system as recited in claim 20, wherein the processor generates the utilization report according to the covered entity, the contracted pharmacy, patient, and NDC.