METHODS AND SYSTEMS FOR MANAGING PRESCRIPTION DRUG BENEFIT PLANS
First Claim
1. A method for managing payments between a prescription drug benefits manager (PBM), a pharmacy, and a client of the PBM, the payments made in accordance with a prescription drug benefits plan offered by the client to an individual and managed by the PBM, said method comprising:
- receiving transaction data associated with a first prescription drug transaction from the pharmacy, the transaction data including data identifying the prescription drug benefits plan and data identifying a first medication and a dosage of the first medication;
determining at least one of a pharmacy discount goal and a client discount goal; and
determining at least one of an actual pharmacy discount provided by the PBM to the pharmacy over a predefined period of time, and an actual client discount provided by the PBM to the client over the predefined period of time.
1 Assignment
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Accused Products
Abstract
A method for managing payments between a prescription drug benefits manager (PBM), a pharmacy, and a client of the PBM is described. The payments are made in accordance with a prescription drug benefits plan offered by the client to an individual and managed by the PBM. The method includes receiving transaction data associated with a first prescription drug transaction from the pharmacy, the transaction data including data identifying the prescription drug benefits plan and data identifying a first medication and a dosage of the first medication. The method also includes determining at least one of a pharmacy discount goal and a client discount goal. The method also includes determining at least one of an actual pharmacy discount provided by the PBM to the pharmacy over a predefined period of time, and an actual client discount provided by the PBM to the client over the predefined period of time.
41 Citations
20 Claims
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1. A method for managing payments between a prescription drug benefits manager (PBM), a pharmacy, and a client of the PBM, the payments made in accordance with a prescription drug benefits plan offered by the client to an individual and managed by the PBM, said method comprising:
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receiving transaction data associated with a first prescription drug transaction from the pharmacy, the transaction data including data identifying the prescription drug benefits plan and data identifying a first medication and a dosage of the first medication; determining at least one of a pharmacy discount goal and a client discount goal; and determining at least one of an actual pharmacy discount provided by the PBM to the pharmacy over a predefined period of time, and an actual client discount provided by the PBM to the client over the predefined period of time. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. A system for managing payments between a prescription drug benefits manager (PBM), a pharmacy, and a client of the PBM, the payments made in accordance with a prescription drug benefits plan offered by the client to an individual and managed by the PBM, said system comprising:
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at least one input device associated with the pharmacy; a server system configured to be coupled to said at least one input device, said server system configured to; receive transaction data associated with a first prescription drug transaction from the pharmacy, the transaction data including data identifying the prescription drug benefits plan and data identifying a first medication and a dosage of the first medication; determine at least one of a pharmacy discount goal and a client discount goal; and determine at least one of an actual pharmacy discount provided by the PBM to the pharmacy over a predefined period of time prior to receipt of the transaction data associated with the first prescription drug transaction, and an actual client discount provided by the PBM to the client over the predefined period of time. - View Dependent Claims (15, 16, 17)
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18. A computer program embodied on a computer readable medium for managing payments between a prescription drug benefits manager (PBM), a pharmacy, and a client of the PBM, the payments made in accordance with a prescription drug benefits plan offered by the client to an individual and managed by the PBM, said program comprising at least one code segment that instructs a server system to:
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receive transaction data associated with a first prescription drug transaction from the pharmacy, the transaction data including data identifying the prescription drug benefits plan and data identifying a first medication and a dosage of the first medication; determine at least one of a pharmacy discount goal and a client discount goal; determine at least one of an actual pharmacy discount provided by the PBM to the pharmacy over a predefined period of time, and an actual client discount provided by the PBM to the client over the predefined period of time; and determine at least one of a pharmacy paid ingredient cost for the first prescription drug transaction and a client billed ingredient cost for the first prescription drug transaction, wherein the pharmacy paid ingredient cost is an amount paid by the PBM for reimbursing the pharmacy for performing the first prescription drug transaction, the pharmacy paid ingredient cost based at least partially on the pharmacy discount goal and the actual pharmacy discount, and wherein the client billed ingredient cost is an amount billed by the PBM to reimburse the PBM for performing the first prescription drug transaction, the client billed ingredient cost based at least partially on the client discount goal and the actual client discount. - View Dependent Claims (19, 20)
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Specification