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Method for conducting prescription drug co-payment plans

  • US 7,657,437 B2
  • Filed: 06/27/2003
  • Issued: 02/02/2010
  • Est. Priority Date: 06/27/2002
  • Status: Active Grant
First Claim
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1. A method of providing prescription benefits to subscribers under a subscriber co-pay plan via an electronic communications network to ensure that the subscriber receives a discounted prescription price, the method comprising the steps of:

  • a) identifying a sponsor for a prescription benefits plan;

    b) designing the prescription benefits plan to include a formulary of preferred medications, and to define prescription medications that are covered by the prescription benefits plan;

    c) identifying at least one pharmacy that;

    i) participates in the prescription benefits plan,ii) receives prescriptions for medication and prescription benefit claims from subscribers, andiii) fulfills the prescriptions for a discounted prescription price;

    d) identifying at least one eligible subscriber having a valid credit or debit account with a creditor or institution and wishing to participate in the prescription benefits plan;

    e) enrolling each eligible subscriber who wishes to participate in the prescription benefits plan and generating an electronic file for each of the eligible subscribers;

    f) generating an eligibility profile for each subscriber and storing said eligibility profile in an electronic memory;

    g) establishing a prescription benefits manager to administer the prescription benefits plan;

    h) establishing a prescription claims processor that;

    i) receives claims over the electronic communications network for prescription benefits from a participating pharmacy;

    ii) adjudicates the claims in accordance with the subscriber'"'"'s eligibility profile; and

    iii) upon approval of a claim, charges the subscriber'"'"'s credit or debit account for accepted claims via the electronic communications network, the amount of the charge being equal to the discounted price of the prescription minus a predetermined co-payment which is tendered by the subscriber to the pharmacy at the time of fulfilling the prescription;

    i) making a first payment via the electronic communications network by the creditor to the prescription benefits manager, the first payment being equal to the amount charged to the subscriber'"'"'s account minus a first predetermined service fee to be retained by the creditor;

    j) making a second payment via the electronic communications network by the prescription benefits manager to the pharmacy, the second payment being equal to a predetermined portion of the discounted prescription price; and

    k) making a third payment via the electronic communication network by the prescription benefits manager to the claims processor, the third payment being equal to a second predetermined service fee, wherein the second payment and the third payment are funded by the first payment and whereby the sum of the pre-determined co-payment and the amount charged to the subscriber'"'"'s account is the discounted prescription price paid by the subscriber.

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