PHARMACY BENEFITS MANAGEMENT METHOD AND APPARATUS

• US 20110131059A1
• Filed: 10/14/2010
• Published: 06/02/2011
• Est. Priority Date: 03/20/2000
• Status: Active Grant

• Current Assignee: Rxeob Com LLC
• Original Assignee: Rxeob Com LLC
• Inventors: YORK, Bryan W., OSCAR, Robert S., OUSTERHOUT, Dean T., ROKENBROD, Matthew, BRUSILOVSKY, Ilia, HAUSER, Rob, DIETZ, John E.
• Granted Patent: US 8,296,164 B2
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 20/13 delivered from dispensers

Abstract

A pharmacy benefits management system and method. A processor server has claim information relating to pharmacy benefits claims, and information relating to a claims processing formularly stored therein. A provider server has pharmacy benefits plan structure information stored therein. A management server has price information relating drugs in various classes and a processing module for correlating the claim information with the benefits plan structure information and the formularly information to identify drugs dispensed to patients, expenses associated with the drugs in accordance with the pharmacy benefits plan structure information, alternative drugs in the same class as the drugs and expenses associated with the alternative drugs.

Claims

1. A pharmacy benefits management method comprising the steps of:

downloading claim information relating to pharmacy benefits claims processed by a claims processing facility, said claim information including identification of drugs dispensed to patients;

downloading pharmacy benefits formulary information;

extracting patient pharmacy benefits information from the claim information and displaying a list of pharmacy benefits provided to a particular patient;

prompting a patient to input a response to verify accuracy of the list of pharmacy benefits; and

retaining and processing the response in said prompting step.

2. A method as recited in claim 1 wherein the list of pharmacy benefits comprises a list of drugs dispensed to the patient and dates, quantities, and copayment corresponding to the drugs dispensed to the patient.

3. A pharmacy benefits management method comprising the steps of:

downloading claim information relating to pharmacy benefits claims processed by a claims processing facility, the claim information including identification of drugs dispensed to patients;

downloading pharmacy benefits formulary information;

downloading pharmacy benefits plan structure information;

downloading price information relating to drugs in various classes;

searching the claim information based on a predetermined selected filter; and

displaying a list of patients whose pharmacy benefits correspond to the selected filters.

4. A method as recited in claim 3, further comprising the step of correlating the claim information with the benefits plan structure information, the price information, and the formulary information to thereby identify drugs expenses associated with drugs dispensed to the list of patients in accordance with the pharmacy benefits plan structure information, alternative drugs in the same class as the selected drugs, and expenses associated with the alternative drugs.

5. A method of comparing alternative medication comprising the steps of storing pharmacy benefits formulary information;

storing pharmacy benefits plan structure information;

storing price information relating to drugs in various classes;

designating a particular class of drugs;

correlating the benefits plan structure information, the price information, and the formulary information; and

determining, based on said correlating step, drugs in the particular class and expenses associated with the drugs in the particular class.

6. The method as recited in claim 5, wherein the expenses in said determining step are out of pocket expense for a member of a benefits plan corresponding to the benefits plan structure information.

7. The method as recited in claim 5, wherein said designating step comprises determining a specific drug dispensed to a patient and designating a class for that specific drug.

8. The method as recited in claim 5, wherein the drugs in the particular class are therapeutic alternatives.

9. A method as recited in claim 5, wherein the benefits plan structure information and the formulary information relate to a multi-tier benefits plan.

10. A method as recited in claim 5, wherein the expenses include copayment information and total cost information.

11. A method of designing a pharmacy benefits plan comprising the steps of;

storing pharmacy benefits formulary information;

storing pharmacy benefits plan structure information;

storing price information relating to drugs in various classes;

designating at least one particular drug;

correlating the benefits plan structure information, the price information, and the formulary information to;

determining, based on said correlating step, expenses associated with the drugs in the particular class;

displaying the expenses determined in said correlating step;

changing at least one of the pharmacy benefits formulary information, the pharmacy benefits plan structure information and the particular drug designated in said designating step; and

repeating said determining and designating step after said changing step.

12. The method as recited in claim 11, wherein said designating step comprises designating a type of drug dispensed to patients in a pharmacy benefits plan and said changing step comprises changing the designated drug for at least some of the patients.

13. The method as recited in claim 11, wherein said benefits structure information and said formulary information relate to a multi-tier benefits plan and said changing step comprises changing at least one of copayment level information and coinsurance percentage information.