Pharmacy benefits management method and apparatus
First Claim
1. A pharmacy benefits management system comprising:
- pharmacy benefits means for receiving claim information relating to pharmacy benefits claims processed by a claims processing facility, said claim information including identification of drugs dispensed to individual patients;
management means for receiving pharmacy benefits formulary information and price information relating to drugs in various classes;
provider means for receiving pharmacy benefits plan structure information including deductible information and co-payment information stored therein to determine a recipient'"'"'s prescription benefit plan and identify the subscriber of the prescription benefit plan;
said management means further;
calculates out-of-pocket costs, sponsor costs, and total costs of the drugs dispensed to patients based upon the determined prescription benefit plan, the identified subscriber, the received claim information, the received formulary information, the received pharmacy benefits plan structure, and the received price information;
aggregates the out-of-pocket costs, sponsor costs, and total costs of the drugs dispensed to patients based upon at least one of identity of drug dispensed, type of drug dispensed, formulary information, identity of pharmacy dispensing drug, and identity of doctor prescribing drug; and
transmits the aggregated out-of-pocket costs and sponsor costs to the recipient of prescription benefits.
2 Assignments
0 Petitions
Accused Products
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.
25 Citations
25 Claims
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1. A pharmacy benefits management system comprising:
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pharmacy benefits means for receiving claim information relating to pharmacy benefits claims processed by a claims processing facility, said claim information including identification of drugs dispensed to individual patients; management means for receiving pharmacy benefits formulary information and price information relating to drugs in various classes; provider means for receiving pharmacy benefits plan structure information including deductible information and co-payment information stored therein to determine a recipient'"'"'s prescription benefit plan and identify the subscriber of the prescription benefit plan; said management means further; calculates out-of-pocket costs, sponsor costs, and total costs of the drugs dispensed to patients based upon the determined prescription benefit plan, the identified subscriber, the received claim information, the received formulary information, the received pharmacy benefits plan structure, and the received price information; aggregates the out-of-pocket costs, sponsor costs, and total costs of the drugs dispensed to patients based upon at least one of identity of drug dispensed, type of drug dispensed, formulary information, identity of pharmacy dispensing drug, and identity of doctor prescribing drug; and transmits the aggregated out-of-pocket costs and sponsor costs to the recipient of prescription benefits. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A pharmacy benefits management method comprising the steps of:
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receiving claim information from a pharmacy benefits server, the claim information relating to pharmacy benefits claims processed by a claims processing facility, said claim information including identification of drugs dispensed to individual patients; receiving pharmacy benefits formulary information from the pharmacy benefits server; receiving pharmacy benefits plan structure information from a provider server, the pharmacy benefits plan structure including deductible information and co-payment information; receiving price information from a management server, the price information relating to drugs in various classes; determining a recipient'"'"'s prescription benefit plan; identifying a subscriber of the recipient'"'"'s prescription benefit plan; calculating, by the management server, out-of-pocket costs, sponsor costs, and total costs of the drugs dispensed to patients based upon the determined prescription benefit plan, the identified subscriber, the received claim information, the received formulary information, the received pharmacy benefits plan structure, and the received price information; aggregating, by the management server, the out-of-pocket costs, sponsor costs, and total costs of the drugs dispensed to patients based upon at least one of identity of drug dispensed, type of drug dispensed, formulary information, identity of pharmacy dispensing drug, and identity of doctor prescribing drug; and transmitting the aggregate out-of-pocket costs and sponsor costs to the recipient of prescription benefits. - View Dependent Claims (14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25)
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Specification