METHOD FOR PROVIDING CONSUMER CHOICE AND EQUALIZING PHARMACY PROVIDER AVAILABILITY IN PRESCRIPTION MEDICATION DISPENSING PLANS

• US 20100287002A1
• Filed: 07/21/2010
• Published: 11/11/2010
• Est. Priority Date: 02/11/2005
• Status: Active Grant

• Current Assignee: Medimpact Healthcare Systems Incorporated
• Original Assignee: Medimpact Healthcare Systems Incorporated
• Inventors: Howe, Frederick, Barre, William J., Brown, Dale R.
• Granted Patent: US 11,865,199 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: A61K 8/66 Enzymes
• CPC Class Codes: A61K 8/732 Starch; Amylose; Amylopectin; Derivatives thereof
• CPC Class Codes: A61Q 19/08 Anti-ageing preparations
• CPC Class Codes: G06Q 30/06 Buying, selling or leasing transactions
• 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

A method is disclosed whereby consumers enrolled in a prescription benefit plan can obtain prescription medication fulfillment at any participating pharmacy of their choice, regardless of whether the fulfillment is by a retail pharmacy or a mail order pharmacy, and whether the quantity of medication prescribed is for administration over a short period (acute care) or a prolonged period (maintenance). The plan of this invention operates by having the plan manager substantially equalize the financial effects of the discounts and services fees allowed to participating pharmacies such that both retail and mail order pharmacies are compensated in a manner which encourages them to accept all consumers and fill all prescriptions. Compensation is preferably adjusted periodically by the manager to retain pharmacy incentives. Consumers obtain choice of pharmacies, plan payers have pleased employees and members and pharmacies obtain income from the entire spectrum of consumers.

Claims

1. A computer system configured to perform a method of adjudicating claims for prescription drugs, the method comprising:

inputting, by the computer system, a single control number corresponding to at least a first fulfillment time period and a second fulfillment time period for a prescription drug;

inputting, by the computer system, a dosage for the prescription drug;

inputting, by the computer system, a quantity of the prescription drug;

transmitting, by the computer system, an order for the prescription drug comprising the single control number, the dosage, and the quantity to a manager that is configured to;

identify the prescription drug based on the single control number;

determine whether to fill the order using the first fulfillment time period or the second fulfillment time period.

2. The computer system of claim 1, wherein the manager is further configured to determine whether to fill the order using the first fulfillment time period or the second fulfillment time period based on the lesser of a cost of fulfilling the order as between the first fulfillment time period and the second fulfillment time period.

3. The computer system of claim 1, further comprising receiving an approval from the manager, the approval corresponding to the first fulfillment time period or the second fulfillment time period.

4. The computer system of claim 1, further comprising inputting a business identification number (BIN) that identifies the manager.

5. The computer system of claim 1, wherein the prescription drug comprises a generic drug.

6. The computer system of claim 1, wherein the first fulfillment time period corresponds to a 30-day period and the second fulfillment time period corresponds to a 90-day period.

7. The computer system of claim 1, wherein the single control number comprises a processor control number (PCN).

8. The computer system of claim 1, wherein the first fulfillment period has a first cost and the second fulfillment period has a second cost.

9. The computer system of claim 8, wherein the first cost and the second cost are based on a maximum allowable cost (MAC) for the prescription drug.

10. A computer system configured to perform a method of adjudicating claims for prescription drugs, the method comprising:

receiving, by the computer system, an order for a prescription drug, the order comprising a dosage, a quantity, and a single control number, the single control number corresponding to at least a first fulfillment time period and a second fulfillment time period for the prescription drug;

identifying, by the computer system, the prescription drug based upon the single control number; and

determining, by the computer system, whether to fill the order using the first fulfillment time period or the second fulfillment time period.

11. The computer system of claim 10, further comprising selecting the first or the second fulfillment time period based upon the time period associated with a lower cost.

12. The computer system of claim 10, wherein the first fulfillment period has a first cost and the second fulfillment period has a second cost, and further comprising filling the order based upon the lower of the first and second costs.

13. The computer system of claim 12, wherein the first cost and the second cost are based on a maximum allowable cost (MAC) for the prescription drug.

14. The computer system of claim 10, further comprising transmitting an approval corresponding to the first fulfillment time period or the second fulfillment time period.

15. The computer system of claim 10, wherein the prescription drug comprises a generic drug.

16. The computer system of claim 10, wherein the first fulfillment time period corresponds to a 30-day period and the second fulfillment time period corresponds to a 90-day period.

17. The computer system of claim 10, wherein the single control number comprises a processor control number (PCN).