METHODS AND SYSTEMS FOR IMPLEMENTATION OF THERAPY PROGRAMS
First Claim
Patent Images
1. A method comprising:
- determining, on a processor, that a member is enrolled in a drug benefit program;
determining, on the processor, that a decision deadline has occurred for continuing an aspect of a benefit of the drug benefit program;
determining, on the processor, that a decision response has not been received from the member; and
generating, on the processor, a suspension of the aspect of the benefit of the drug benefit program based on the determination that the decision response has not been received from the member.
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Accused Products
Abstract
Methods and systems for implementation of therapy programs are described. In one embodiment, it is determined that a member is enrolled in a drug benefit program. It is determined that a decision deadline has occurred for continuing an aspect of a benefit of the drug benefit program. It is determined that a decision response has not been received from the member. A suspension of the aspect of the benefit of the drug benefit program is generated based on the determination that the decision response has not been received from the member. Other methods and systems are described.
11 Citations
24 Claims
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1. A method comprising:
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determining, on a processor, that a member is enrolled in a drug benefit program; determining, on the processor, that a decision deadline has occurred for continuing an aspect of a benefit of the drug benefit program; determining, on the processor, that a decision response has not been received from the member; and generating, on the processor, a suspension of the aspect of the benefit of the drug benefit program based on the determination that the decision response has not been received from the member. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8)
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9. A method comprising:
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determining, on a processor, that a member of a drug benefit program qualifies for a therapy implementation program associated with the drug benefit program; generating, on the processor, a notification for the member based on the determination that the member qualifies for the therapy implementation program; determining, on the processor, that a member response has not been received; and altering, on the processor, an aspect of a benefit of the drug benefit program based on the determination that the member response has not been received. - View Dependent Claims (10, 11, 12, 13, 14)
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15. A method comprising:
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determining, on a processor, that a member of a drug benefit program qualifies for a prescription drug home delivery program associated with the drug benefit program; generating, on the processor, a notification for the member based on the determination that the member qualifies for the prescription drug home delivery program; determining, on the processor, that a member response has not been received before the occurrence of a decision deadline; and altering, on the processor, a retail pharmacy coverage aspect of the drug benefit program based on the determination that the member response has not been received. - View Dependent Claims (16, 17)
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18. A method comprising:
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determining, on a processor, that a member of a drug benefit program qualifies for a value-enhanced pharmacy network program associated with the drug benefit program; generating, on the processor, a notification for the member based on the determination that the member qualifies for the value-enhanced pharmacy network program associated with the drug benefit program; determining, on the processor, that a member response has not been received before the occurrence of a decision deadline; and altering, on the processor, a pharmacy network selection coverage of the drug benefit program based on the determination that the member response has not been received. - View Dependent Claims (19, 20)
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21. A method comprising:
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determining, on a processor, that a member of a drug benefit program qualifies for a prescription drug selection program associated with the drug benefit program; generating, on the processor, a notification for the member based on the determination that the member qualifies for the prescription drug selection program; determining, on the processor, that a member response has not been received before the occurrence of a decision deadline; and altering, on the processor, a prescription drug selection aspect of the drug benefit program based on the determination that the member response has not been received. - View Dependent Claims (22, 23)
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24. A non-transitory machine-readable medium comprising instructions, which when executed by one or more processors, cause the one or more processors to perform the following operations:
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determine that a member is enrolled in a drug benefit program; determine that a decision deadline has occurred for continuing an aspect of a benefit of the drug benefit program; determine that a decision response has not been received from the member; and generate a suspension of the aspect of the benefit of the drug benefit program based on the determination that the decision response has not been received from the member.
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Specification