SYSTEMS AND METHODS FOR CONTROLLING A REPLENISHMENT PROGRAM THROUGH A CONTRACT PHARMACY

• US 20090326975A1
• Filed: 06/25/2008
• Published: 12/31/2009
• Est. Priority Date: 06/25/2008
• Status: Abandoned Application

• Current Assignee: Wellpartner, Inc. (CVS Health Corporation)
• Original Assignee: Wellpartner, Inc. (CVS Health Corporation)
• Inventors: Sawyer, Daniel Dean, Hardaway, Jason Michael
• Application Number:
  US12/145,960
• Publication Number:
  US 20090326975A1
• 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: G06Q 40/08 Insurance
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

The existing infrastructure of a pharmacy may be extended to allow the pharmacy to service patients of one or more qualified entities that are entitled to discounted drugs through one or more qualified programs (e.g., 340B, GPO, PAP, or the like). One or more data structures of the systems already in place at the pharmacy may be leveraged to store data relating to the qualified entity and/or qualified program that covering the patients served by the pharmacy. This data used to comply with the regulatory requirements of the qualifying programs under which the drugs are obtained. The data may also be used to track inventory loaned to the qualifying entity from a common inventory of the pharmacy. The inventory information may be used to replenish the loaned inventory as needed, identify alternative, equivalent drugs for use in replenishment, and manage the reimbursement and financial reconciliation elements of the qualified programs.

Claims

1. A computer system to allow a pharmacy to serve patients of a plurality of qualified entities, the system comprising:

a processor;

an output device in electrical communication with the processor; and

a memory in electrical communication with the processor, the memory comprising,

an operating system, and

a qualified program management module to perform the method of,

enabling dispensing of drugs to the patients of the plurality of qualified entities from a common inventory of the pharmacy, wherein each of the qualified entities is entitled to reduced cost drugs under a respective qualified program,

monitoring the drugs dispensed to the patients of each of the plurality of qualified entities from the common inventory,

generating a report of the drugs dispensed to patients of a particular qualified entity, wherein the report is generated according to regulations of a respective qualified program of the particular qualified entity, and

enabling the replenishment of the drugs dispensed to the patients of the particular qualified entity, wherein the drugs are replenished according to the regulations of the respective qualified program of the particular qualified entity.

2. The system of claim 1, wherein the regulations of the qualified program of the particular qualified entity provide for bill-to/ship-to replenishment.

3. The system of claim 2, wherein replenishment drugs to replenish the drugs dispensed to the patients of the particular qualified entity are shipped directly to the pharmacy from a manufacturer and/or a wholesaler of the replenishment drugs.

4. The system of claim 3, wherein a payment for the replenishment drugs is made directly by the particular qualified entity to the manufacturer and/or wholesaler of the replenishment drugs.

5. The system of claim 4, wherein the method performed by the qualified program management module further comprises:

enabling reimbursement of the particular qualified entity for a difference between a disbursement cost of the drugs dispensed to the patients of the qualified entity and a cost of the replenishment drugs.

6. The system of claim 1, wherein the method performed by the qualified program management module further comprises:

identifying an alternative, equivalent drug available to replenish the drugs dispensed to the patients of the particular qualified entity.

7. The system of claim 6, wherein identifying the alternative, equivalent drug comprises identifying a reduced cost drug available for purchase by the particular qualified entity.

8. The system of claim 7, wherein the alternative, equivalent drug is a drug available for purchase according to the qualified program of the particular qualified entity.

9. The system of claim 6, wherein the qualified program management module uses a national drug code (NDC) of one or more of the drugs dispensed to the patients of the particular qualified entity to identify the alternative, equivalent drug.

10. The system of claim 1, further comprising an adjudication system, wherein the method performed by the qualified program management module further comprises:

using the adjudication system to monitor drugs dispensed to the patients of the plurality of qualified entities.

11. The system of claim 10, wherein using the adjudication system to monitor drugs dispensed to the patients of the plurality of qualified entities comprises storing data relating to the drugs dispensed to the patients of the plurality of qualified entities in a data structure of the adjudication system.

12. The system of claim 11, wherein the adjudication system data structure complies with a data structure specification promulgated by the National Council for Prescription Drug Programs (NCPDP).

13. The system of claim 11, wherein the adjudication system comprises a coordination of benefits (COB) system, and wherein using the adjudication system to monitor the drugs dispensed to the patients of the plurality of qualified entities comprises storing data relating to the drugs dispensed to the patients of the plurality of qualified entities in a data structure of the COB system.

14. The system of claim 11, wherein the method performed by the qualified program management module further comprises:

filtering one or more adjudication system data structures to obtain data relating to the drugs dispensed to the patients of the plurality of qualified entities.

15. The system of claim 1, wherein a qualified program of one of the plurality of qualified entities is selected from the group consisting of a 340B program, a Group Purchasing Organization (GPO), and a Patient Assistance Program (PAP).

16. A computer readable storage medium, having stored thereon computer readable instruction code for performing a method to allow a contract pharmacy to serve patients of a plurality of qualified entities, the method comprising:

enabling dispensing of drugs to the patients of the plurality of qualified entities from a common inventory of the contract pharmacy, wherein each of the qualified entities is entitled to reduced cost drugs under a respective qualified program;

monitoring the drugs dispensed to the patients of each of the plurality of qualified entities from the common inventory;

generating a report of the drugs dispensed to patients of a particular qualified entity, wherein the report is generated according to regulations of a respective qualified program of the particular qualified entity; and

enabling replenishment of the drugs dispensed to the patients of the particular qualified entity, wherein the drugs are replenished according to the regulations of the respective qualified program of the particular qualified entity.

17. The computer readable storage medium of claim 16, wherein the regulations of the qualified program of the particular qualified entity provide for bill-to/ship-to replenishment.

18. The computer readable storage medium of claim 17, wherein the method further comprises:

enabling the particular qualified entity to provide payment for the replenishment drugs directly to a provider of the replenishment drug.

19. The computer readable storage medium of claim 17, wherein the method further comprises:

enabling reimbursement of the particular qualified entity for a difference between a cost of the drugs dispensed to the patients of the particular entity and a cost of the replenishment drugs.

20. The computer readable storage medium of claim 16, wherein the method further comprises:

identifying an alternative, equivalent drug available to replenish the drugs dispensed to the patients of the particular qualified entity.

21. The computer readable storage medium of claim 20, wherein identifying the alternative, equivalent drug comprises identifying a reduced cost drug available for purchase by the particular qualified entity.

22. The computer readable storage medium of claim 21, wherein the alternative, equivalent drug is available for purchase according to the qualified program of the particular qualified entity.

23. The computer readable storage medium of claim 20, wherein a national drug code (NDC) of one or more of the drugs dispensed to the patients of the particular qualified entity is used to identify the alternative, equivalent drug.

24. The computer readable storage medium of claim 16, wherein the method further comprises:

using an adjudication system of the contract pharmacy to monitor the drugs dispensed to the patients of the plurality of qualified entities.

25. The computer readable storage medium of claim 24, wherein using the adjudication system to monitor the drugs dispensed to the patients of the plurality of qualified entities comprises storing data relating to the drugs dispensed to the patients of the plurality of qualified entities in a data structure of the adjudication system.

26. The computer readable storage medium of claim 25, wherein the adjudication system data structure complies with a data structure specification promulgated by the National Council for Prescription Drug Programs (NCPDP).

27. The computer readable storage medium of claim 25, wherein the adjudication system of the contract pharmacy comprises a coordination of benefits (COB) system, and wherein using the adjudication system to monitor drugs dispensed to the patients of the plurality of qualified entities comprises storing data relating to the drugs dispensed to the patients of the plurality of qualified entities in a data structure of the COB system.

28. The computer readable storage medium of claim 25, wherein the method further comprises:

filtering one or more adjudication system data structures to obtain data relating to drug dispensed to the patients of the plurality of qualified entities.

29. The computer readable storage medium of claim 16, wherein a qualified program of one of the plurality of qualified entities is selected from the group consisting of a 340B program, a Group Purchasing Organization (GPO), and a Patient Assistance Program (PAP).

30. A method to allow a pharmacy to serve patients of a plurality of qualified entities, comprising:

providing for dispensing of drugs to the patients of the plurality of qualified entities from a common inventory of the pharmacy, wherein each of the qualified entities is entitled to reduced cost drug under a respective qualified program;

monitoring the drugs dispensed to the patients of the plurality of qualified entities using a computer system;

automatically generating a report of the drugs dispensed to patients of a particular qualified entity, wherein the report is generated according to regulations of a qualified program of the particular qualified entity;

providing for automatic replenishment of the drugs dispensed to the patients of the particular qualified entity, wherein the replenishment drugs are obtained according to the regulations of the qualified program of the particular qualified entity.

31. The method of claim 30, wherein the pharmacy comprises an adjudication system, the method further comprising:

storing data related to the drugs dispensed to the patients of the plurality of qualified entities in a data structure of the adjudication system.

32. The method of claim 31, wherein generating the report for the particular qualified entity comprises filtering a plurality of adjudication system data structures to obtain data relating to the drugs dispensed to the patients of the particular qualified entity.

33. The system of claim 31, wherein the adjudication system comprises a coordination of benefits (COB) system, and wherein storing data related to the drugs dispensed to the patients of the plurality of qualified entities comprises storing data relating to the drugs dispensed to the patients of the plurality of qualified entities in a data structure of the COB system.

34. The method of claim 31, wherein automatically replenishing the drugs dispensed to the patients of the particular qualified entity comprises filtering a plurality of adjudication system data structures to obtain data relating to the drugs dispensed to the patients of the particular qualified entity.

35. The method of claim 30, further comprising automatically identifying an alternative, equivalent drug to replenish the drug dispensed to the patients of the particular qualified entity using a National Drug Code of one or more of the drugs dispensed to the patients of the particular qualified entity.