APPARATUS AND METHOD FOR MANAGING PRESCRIPTION BENEFITS
First Claim
1. A method of managing prescription benefits offered by a plurality of providers of prescription benefits, comprising:
- storing prescription benefit case records in a prescription benefits management computer system for users at least one of receiving or administrating one of a plurality of prescription benefits coverage plans from at least one of the plurality of providers of prescription benefits, said prescription benefit case records comprising information regarding patients and prescription coverage activities including at least one of a type of treatment associated with the prescription benefits coverage, pharmaceutical product used by the patient when present, and a number and type of communications with the patient associated with the prescription benefits coverage, accessible to the users responsive to the one of the plurality of prescription benefits coverage plans;
providing access to the plurality of prescription benefits coverage plans from the at least one of the plurality of providers of prescription benefits using said prescription benefits management computer system to respective plurality of providers of prescription benefits over one or more electronic communication networks;
receiving a request to access said prescription benefits management computer system from the user of at least one of the plurality of providers of prescription benefits from remote locations via one or more electronic communication networks, wherein access to said prescription benefits management computer system is provided based on at least one of a plurality of preconfigured access rights corresponding to at least one of the user and the provider of the prescription benefits offered through the one of the plurality of prescription benefits coverage plans from the at least one the plurality of providers of prescription benefits;
selecting at least one of a plurality of prescription coverage activities contained in said prescription benefit case records corresponding to the prescription benefits coverage plan;
conducting an inquiry on said prescription benefit case records to view and reviewing selected prescription coverage activities contained in said prescription benefit case records responsive to the request from the user, wherein the inquiry to view and review the selected prescription coverage activities further comprises displaying a plurality of options to access said prescription coverage activities for the user based on the at least one of a plurality of preconfigured access rights, and selecting at least one of the plurality of options to access said prescription coverage activities,reviewing details of the prescription coverages, and at least one of overriding the displayed prescription coverage based on one or more clinical and prescription criteria, replacing an original prescription product with a substitute prescription product that is covered by a prescription benefit plan associated with the case record, and appealing the prescription coverage denial based on clinical reasons in response to receiving a request from the user,selecting a new prescription benefit case record for prescription benefits,determining whether the new case record is currently being viewed by a second user,receiving instructions from user to release the new case record if the new case record is currently being viewed by the second user,determining whether the user is an employee of at least one organization, offering the one of the plurality of prescription benefits coverage plans from the at least one of the plurality of providers of prescription benefits, implementing the prescription benefits management computer system,releasing the new prescription case record without the second user'"'"'s authorization if the second user is at least one of an employee and a client of the organization implementing the prescription benefits management computer system, and closing said prescription benefit case records.
4 Assignments
0 Petitions
Accused Products
Abstract
A system and method are disclosed for managing prescription benefits. Case records containing information regarding patients and prescription coverage activities for the patients are stored in the system. Users are allowed access to the system via an appropriate electronic communication network. The user can subsequently perform various tasks in order to maintain and review coverage activities. The user can also enter additional prescription coverage activities into the case records, as well as verify that information entered into the case records has been updated.
6 Citations
31 Claims
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1. A method of managing prescription benefits offered by a plurality of providers of prescription benefits, comprising:
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storing prescription benefit case records in a prescription benefits management computer system for users at least one of receiving or administrating one of a plurality of prescription benefits coverage plans from at least one of the plurality of providers of prescription benefits, said prescription benefit case records comprising information regarding patients and prescription coverage activities including at least one of a type of treatment associated with the prescription benefits coverage, pharmaceutical product used by the patient when present, and a number and type of communications with the patient associated with the prescription benefits coverage, accessible to the users responsive to the one of the plurality of prescription benefits coverage plans; providing access to the plurality of prescription benefits coverage plans from the at least one of the plurality of providers of prescription benefits using said prescription benefits management computer system to respective plurality of providers of prescription benefits over one or more electronic communication networks; receiving a request to access said prescription benefits management computer system from the user of at least one of the plurality of providers of prescription benefits from remote locations via one or more electronic communication networks, wherein access to said prescription benefits management computer system is provided based on at least one of a plurality of preconfigured access rights corresponding to at least one of the user and the provider of the prescription benefits offered through the one of the plurality of prescription benefits coverage plans from the at least one the plurality of providers of prescription benefits; selecting at least one of a plurality of prescription coverage activities contained in said prescription benefit case records corresponding to the prescription benefits coverage plan; conducting an inquiry on said prescription benefit case records to view and reviewing selected prescription coverage activities contained in said prescription benefit case records responsive to the request from the user, wherein the inquiry to view and review the selected prescription coverage activities further comprises displaying a plurality of options to access said prescription coverage activities for the user based on the at least one of a plurality of preconfigured access rights, and selecting at least one of the plurality of options to access said prescription coverage activities, reviewing details of the prescription coverages, and at least one of overriding the displayed prescription coverage based on one or more clinical and prescription criteria, replacing an original prescription product with a substitute prescription product that is covered by a prescription benefit plan associated with the case record, and appealing the prescription coverage denial based on clinical reasons in response to receiving a request from the user, selecting a new prescription benefit case record for prescription benefits, determining whether the new case record is currently being viewed by a second user, receiving instructions from user to release the new case record if the new case record is currently being viewed by the second user, determining whether the user is an employee of at least one organization, offering the one of the plurality of prescription benefits coverage plans from the at least one of the plurality of providers of prescription benefits, implementing the prescription benefits management computer system, releasing the new prescription case record without the second user'"'"'s authorization if the second user is at least one of an employee and a client of the organization implementing the prescription benefits management computer system, and closing said prescription benefit case records. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29)
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30. A system for managing prescription benefits offered by a plurality of providers of prescription benefits, comprising:
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a prescription benefits management computer system, for storing prescription benefit case records for patients receiving one of a plurality of prescription benefits coverage for the plurality of providers of prescription benefits, said prescription benefit case records comprising information regarding the patients and prescription coverage activities including at least one of a type of treatment associated with the prescription benefits coverage, pharmaceutical product used by the patient when present, and a number and type of communications with the patient associated with the prescription benefits coverage, pharmaceutical product used by the patient when present, and a number and type of communications with the patient associated with the prescription benefits coverage, accessible to the patient responsive to the one of the plurality of prescription benefits coverage plans; a communication device operatively coupled to said prescription benefits management computer system for providing access to the plurality of prescription benefits coverage plans from the at least one of the plurality of providers of prescription benefits using said prescription benefits management computer system to respective plurality of providers of prescription benefits over one or more electronic communication networks; and said prescription benefits management computer system for receiving a request to access said prescription benefits management computer system from a user of at least one of the plurality of providers of prescription benefits utilizing at least one user computer from remote locations via said one or more electronic communication networks, wherein access to said prescription benefits management computer system is provided based on at least one of a plurality of preconfigured access right corresponding to at least one of the user and the provider of the prescription benefits offered through the one of the plurality of prescription benefits coverage plans from the at least one of the plurality of providers of prescription benefits;
said prescription benefits management computer system being configured to allow users to;select at least one of a plurality of prescription coverage activities contained in said prescription benefit case records corresponding to the prescription benefits coverage plan; conduct an inquiry on said prescription benefit case records to view and review selected prescription coverage activities contained in said prescription benefit case records responsive to the request from the user, wherein the inquiry to view and review the selected prescription coverage activities further comprises displaying a plurality of options to access said prescription coverage activities for the patient based on the at least one of a plurality of preconfigured access right, and selecting at least one of the plurality of options to access said prescription coverage activities, display one or more reasons for each prescription coverage, and reviewing details of the displayed reasons, and at least one of overriding the displayed prescription coverage denial based on one or more clinical and prescription criteria, replacing an original prescription product with a substitute prescription product that is covered by a prescription benefit plan associated with the case record, and appealing the prescription coverage denial based on clinical reasons in response to receiving a request from a user, select a new prescription benefit case record for prescription benefits, determine whether the new case record is currently being viewed by a second user, receive instructions from user to release the new case record if the new case record is currently being viewed by the second user, determine whether the user is an employee of at least one organization, offering the one of the plurality of prescription benefits coverage plans from the at least one of the plurality of providers of prescription benefits, implementing the prescription benefits management computer system, release the new prescription case record without the second user'"'"'s authorization if the second user is at least one of an employee and a client of the organization implementing the prescription benefits management computer system, modify information contained in the prescription benefit case record, and close said prescription benefit case records.
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31. A method of managing prescription benefits offered by a plurality of providers of prescription benefits, comprising:
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storing prescription benefit case records in at least a prescription benefits management computer system for users receiving and/or administrating one of a plurality of prescription benefits coverage-plans from at least one of the plurality of providers of prescription benefits; providing access to the plurality of prescription benefits coverage plans from the at least one of the plurality of providers of prescription benefits using said prescription benefits management computer system to respective plurality of providers of prescription benefits over one or more electronic communication networks; receiving a request to access said prescription benefits management computer system from a user of at least one of the plurality of providers of prescription benefits from remote locations via one or more electronic communication networks, wherein access to said prescription benefits management computer system is provided based on at least one of a plurality of preconfigured access right corresponding to at least one of the user and the provider of the prescription benefits offered through the one of the plurality of prescription benefits coverage plans from the at least one of the plurality of providers of prescription benefits; selecting at least one of a plurality of prescription coverage activities contained in said prescription benefit case records corresponding to the prescription benefits coverage plan; conducting an inquiry on said prescription benefit case records to view and reviewing selected prescription coverage activities contained in said prescription benefit case records responsive to the request from the user, wherein the inquiry to view and review the selected prescription coverage activities further comprises displaying a plurality of options to access said prescription coverage activities for the at least one patient based on the at least one of a plurality of preconfigured access rights, and selecting at least one of the plurality of options to access said prescription coverage activities, generating one or more reasons for each prescription coverage, and reviewing details of the displayed reasons, and at least one of overriding the displayed prescription coverage denial based on one or more clinical and prescription criteria, replacing an original prescription product with a substitute prescription product that is covered by a prescription benefit plan associated with the case record, and appealing the prescription coverage denial based on clinical reasons in response to receiving a request from the user, selecting a new prescription benefit case record for prescription benefits, determining whether the new case record is currently being viewed by a second user, releasing the new prescription case record without the second user'"'"'s authorization when the user is determined to be the a clinical user, modifying information contained in the prescription benefit case record, and closing said prescription benefit case records.
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Specification