Using a non-profit organization to satisfy medicare out-of-pocket/troop and product replacement

• US 7,805,318 B1
• Filed: 11/14/2007
• Issued: 09/28/2010
• Est. Priority Date: 11/17/2006
• Status: Active Grant

• Current Assignee: Patient Services, Inc.
• Original Assignee: Patient Services, Inc.
• Inventors: Kuhn, Dana A.
• Primary Examiner(s): Morgan; Robert W
• Assistant Examiner(s): BURGESS, JOSEPH D
• Application Number:
  US11/939,980
• Time in Patent Office: 1,049 Days
• Field of Search: 705 2- 3
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 20/13 delivered from dispensers

Abstract

A process of providing needy Medicare recipients with financial help in addressing medical care by setting up a non-profit organization, receiving donated pharmaceutical product from pharmaceutical manufacturers to the non-profit organization, inventorying the drug product received from the pharmaceutical manufacturers in a contracted or non-profit pharmacy, and taking title of the drug product from the pharmaceutical manufacturers. The drug product replaces a drug product used by the Medicare recipients and the drug product accounts toward the recipient'"'"'s true out-of-pocket payment (TrOOP).

Claims

1. A process of providing recipients with financial help in addressing medical care comprising:

receiving a pharmaceutical drug from a donor pharmaceutical manufacturer;

inventorying the drug received from the pharmaceutical manufacturer;

taking title of the drug from the pharmaceutical manufacturer;

pre-qualifying by a computer processor a recipient for eligibility to receive donated drugs;

determining an amount of allowable eligibility for the recipient based on a difference between an annual maximum true out-of-pocket (TrOOP) threshold and any previous true out-of-pocket payments made by the recipient including an amount of donated drug previously received by the recipient;

dispensing the drug to the recipient based on said pre-qualifying step and the amount of eligibility;

sending by the computer processor an automated message indicating an amount of a non-payable claim, wherein the amount of the non-payable claim includes a value of the drug to be credited toward the recipient'"'"'s true out-of-pocket payment; and

crediting the value of the drug toward the recipient'"'"'s true out-of-pocket payment.

2. The process according to claim 1, wherein the recipient is a Medicare recipient.

3. The process according to claim 1, wherein the-drug is received, and dispensed by a non-profit pharmacy organization.

4. The process according to claim 1, wherein said step of pre-qualifying is based on the recipients previous coverage for the drug.

5. The process according to claim 4, wherein the previous coverage for the drug is Medicare coverage.

6. The process according to claim 1, wherein said step of pre-qualifying is based on the recipient'"'"'s income.

7. The process according to claim 1, further comprising the step of halting the dispensing of the at least one drug when a predetermined amount of the drug has been dispensed.

8. The process according to claim 7, wherein the predetermined amount is based on the cost of the drug.

9. The process according to claim 7, wherein said step of halting is based on the recipient being eligible for coverage for the drug after receiving the predetermined amount.

10. A system for providing recipients with financial help in addressing medical care, the system comprising:

a processor;

a memory; and

a communication device,

wherein, the system is programmed with computer instructions that cause the processor to perform the steps of;

inventorying drugs received from one or more pharmaceutical manufacturers;

pre-qualifying a recipient for eligibility;

determining an amount of allowable eligibility for the recipient based on a difference between an annual maximum true out-of-pocket (TrOOP) threshold and any previous true out-of-pocket payments made by the recipient including an amount of donated drug previously received by the recipient;

dispensing at least one of the drugs to the recipient based on said pre-qualifying step and the amount of allowable eligibility; and

sending an automated message regarding the dispensing of the at least one of the drugs including an indicator of an amount of a non-payable claim, wherein the amount of the non-payable claim includes a value of the at least one of the drugs to be credited toward the recipient'"'"'s true out-of-pocket payment; and

crediting the value of the at least one of the drugs toward the recipient'"'"'s true out-of-pocket payment.

11. The system according to claim 10, wherein the recipient is a Medicare recipient.

12. The system according to claim 10, wherein the inventorying and dispensing are performed by a non-profit pharmacy organization.

13. The system according to claim 10, wherein the pre-qualifying is based on the recipient'"'"'s previous coverage for the drugs.

14. The system according to claim 13, wherein the previous coverage for the drugs is Medicare coverage.

15. The system according to claim 10, wherein the pre-qualifying is based on the recipient'"'"'s income.

16. The system according to claim 10, further comprising computer instructions that cause the processor to perform the step of halting the dispensing of the at least one of the drugs when a predetermined amount of the at least one of the drugs has been dispensed.

17. The system according to claim 16, wherein the predetermined amount is based on the cost of the at least one of the drugs.

18. The system according to claim 16, wherein the halting is based on the recipient being eligible for coverage for the at least one of the drugs after receiving the predetermined amount.