APPARATUS AND METHOD FOR CONSTRUCTING FORMULARIES
First Claim
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1. A method of constructing a formulary, comprising:
- (a) storing a plurality of pharmaceutical products for access by a computer;
(b) storing for access by the computer a plurality of pharmaceutical categories, wherein each pharmaceutical category comprises at least one of;
(i) a category definition based on predetermined relational characteristics shared by the plurality of pharmaceutical products;
(ii) a therapeutic description;
(c) creating a plurality of base formularies comprising the plurality of pharmaceutical products responsive to predetermined criteria, wherein each base formulary comprises at least one pharmaceutical products;
(d) creating, using the computer, a new formulary by;
(i) defining inclusion rules comprising criteria for accepting coverage of non-formulary pharmaceutical products when present;
(ii) selecting at least one of the preexisting base formularies when the selected base formulary'"'"'s inclusion rules are substantially similar to the desired inclusion rules;
(iii) modifying the selected base formulary when additional pharmaceutical products are present by allowing the user to select on the computer the additional pharmaceutical products to be included into the new formulary.
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Abstract
An system for constructing formularies is disclosed. The system includes a central computer system and at least one additional computer. The central computer system compiles a list of various pharmaceutical products and sort them into different categories. Formularies are then created by selecting individual products or categories of products that will be covered. When prescription claims are received, coverage is either accepted or denied based on whether the products in the prescription claims are covered by the formulary.
25 Citations
22 Claims
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1. A method of constructing a formulary, comprising:
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(a) storing a plurality of pharmaceutical products for access by a computer; (b) storing for access by the computer a plurality of pharmaceutical categories, wherein each pharmaceutical category comprises at least one of; (i) a category definition based on predetermined relational characteristics shared by the plurality of pharmaceutical products; (ii) a therapeutic description; (c) creating a plurality of base formularies comprising the plurality of pharmaceutical products responsive to predetermined criteria, wherein each base formulary comprises at least one pharmaceutical products; (d) creating, using the computer, a new formulary by; (i) defining inclusion rules comprising criteria for accepting coverage of non-formulary pharmaceutical products when present; (ii) selecting at least one of the preexisting base formularies when the selected base formulary'"'"'s inclusion rules are substantially similar to the desired inclusion rules; (iii) modifying the selected base formulary when additional pharmaceutical products are present by allowing the user to select on the computer the additional pharmaceutical products to be included into the new formulary. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. A method of constructing a formulary, comprising:
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(a) storing a plurality of pharmaceutical products; (b) storing a plurality of pharmaceutical categories; (c) creating, using the computer, a plurality of base formularies, wherein each base formulary is created by; (i) selecting on the computer at least one of the pharmaceutical products for inclusion in the base formulary, (ii) entering into the computer inclusion rules descriptive of the base formulary; (iii) saving the base formulary in the computer, (d) updating, by the computer, the list of pharmaceutical products in at least one of the plurality of base formularies at predetermined intervals to include newly released pharmaceutical products; (e) selecting, using the computer, additional released pharmaceutical products from the newly released pharmaceutical products to be supported by the at least one of the plurality of formularies, based at least in part on the categories; and (f) creating, using the computer, a plurality of modified formularies responsive to the updating of the list of pharmaceutical products and the selecting of the additional released pharmaceutical products. - View Dependent Claims (15, 16, 17, 18, 19, 20, 21)
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22. A system for constructing a formulary, comprising:
a computer system in communication with a user computing device and at least one database, wherein the computer system is configured to; store a plurality of pharmaceutical products in the at least one database; store a plurality of pharmaceutical categories in the at least one database, wherein each pharmaceutical category comprises at least one of; (i) a category definition based on predetermined relational characteristics shared by the plurality of pharmaceutical products; (ii) a therapeutic description; generate, using the computer system, a plurality of base formularies, wherein each base formulary is generated by; (i) selecting, using the computer system, at least one of the sorted pharmaceutical products for inclusion in the base formulary, (ii) entering into the computer system inclusion rules descriptive of the base formulary; (iii) saving the base formulary by the computer system, update the list of pharmaceutical products in at least one of the plurality of base formularies at predetermined intervals to include newly released pharmaceutical products; select additional released pharmaceutical products from the newly released pharmaceutical products to be supported by the at least one of the plurality of formularies, based at least in part on the at least one of; (i) the category definition based on predetermined relational characteristics shared by the plurality of pharmaceutical products; and (ii) the therapeutic description; and generate, using the computer system, a plurality of modified formularies responsive to the updating of the list of pharmaceutical products and the selecting of the additional released pharmaceutical products.
Specification