Systems and methods for prescription pre-fill processing services

• US 8,036,913 B1
• Filed: 10/28/2008
• Issued: 10/11/2011
• Est. Priority Date: 10/28/2008
• Status: Active Grant

• Current Assignee: McKesson Corp.
• Original Assignee: Mckesson Financial Holdings Limited (McKesson Corp.)
• Inventors: MacKenzie, Scott, Pinsonneault, Roger
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): Patel; Neha
• Application Number:
  US12/259,309
• Time in Patent Office: 1,078 Days
• Field of Search: 705/2, 705/3
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

Systems and methods may be provided for prescription pre-fill processing services, which may include receiving a pre-fill prescription claim request from a pharmacy computer; delivering the pre-fill prescription claim request to a claims processor; and receiving a first approved response from the claims processor, where the first approved response includes first financial coverage information. The systems and methods may also include delivering the first approved response to the pharmacy computer, where a prescription order of the drug or product is prepared for pickup by a customer, where the prepared prescription order is labeled in accordance with the first financial coverage information; delivering a prescription claim reversal request to the claims processor for a second adjudication; and receiving, by switch provider in accordance with the second adjudication, a second approved response that indicates a reversal of the first claim request, where the prepared prescription order of the drug or product remains ready for pickup by the customer.

Claims

1. A computer-implemented method, comprising:

receiving, by a switch provider computer, a pre-fill prescription claim request from a pharmacy computer, wherein the pre-fill prescription claim request identifies a prescribed drug or product for a customer, wherein the pre-fill prescription claim request is based upon anticipating a fill or refill need by the customer for the prescribed drug or product prior to receiving an actual request by the customer to fill or refill the prescribed drug or product;

delivering, by the switch provider computer, the pre-fill prescription claim request to a claims processor for a first adjudication;

receiving, by the switch provider computer in accordance with the first adjudication, a first approved response from the claims processor for the pre-fill prescription claim request, wherein the first approved response includes first financial coverage information;

delivering, by the switch provider computer, the first approved response to the pharmacy computer, wherein in accordance with the delivered first approved response, a prescription order of the drug or product is prepared for pickup by the customer, wherein the prepared prescription order is labeled in accordance with the first financial coverage information;

responsive to the first approved response, automatically delivering, by the switch provider computer, a prescription claim reversal request to the claims processor for a second adjudication; and

receiving, by the switch provider computer in accordance with the second adjudication, a second approved response that indicates a reversal of the request by the claims processor, wherein the prepared prescription order of the drug or product remains ready for pickup by the customer for a period of time subsequent to receiving the second approved response.

2. The computer-implemented method of claim 1, further comprising:

receiving, by the switch provider computer in accordance with a customer pickup of the prepared prescription order, a second prescription claim request from the pharmacy computer, wherein the second prescription claim request identifies the prescribed drug or product;

delivering, by the switch provider computer, the second prescription claim request to the claims processor for a third adjudication;

receiving, by the switch provider computer in accordance with the third adjudication, a third approved response from the claims processor, wherein the third approved response includes second financial coverage information; and

delivering, by the switch provider computer, the third approved response to the pharmacy computer.

3. The computer-implemented method of claim 2, wherein the second financial coverage information is determined to be different than the first financial coverage information, and wherein the prepared prescription order is relabeled in accordance with the second financial coverage information prior to delivery to the customer.

4. The computer-implemented method of claim 3, wherein the pharmacy computer determines that the second financial coverage information is different from the first financial coverage information.

5. The computer-implemented method of claim 3, wherein the switch provider computer delivers a message indicating a difference between the second financial coverage information and the first financial coverage information to the pharmacy computer, wherein the prepared prescription order is relabeled in accordance with the delivered message.

6. The computer-implemented method of claim 1, further comprising:

delivering, to the switch provider computer, a pick-up message from the pharmacy computer, wherein the pick-up message indicates that the prepared prescription order has been picked up by the customer;

identifying, by the switch provider computer based upon information in the pick-up message, the previously received pre-fill prescription claim request;

generating, by the switch provider computer based upon information in the pre-fill prescription claim request, a second prescription claim request;

delivering, by the switch provider computer, the second prescription claim request to the claims processor for a third adjudication; and

receiving, by the switch provider computer in accordance with the third adjudication, a third approved response from the claims processor for the second prescription claim request, wherein the third approved response includes second financial coverage information.

7. The computer-implemented method of claim 6, further comprising:

determining, by the switch provider computer, that the second financial coverage information matches the first financial coverage information; and

delivering, by the switch provider computer, a second message to the pharmacy computer, wherein the second message is indicative of the second financial coverage information matching the first financial coverage information.

8. The computer-implemented method of claim 6, wherein the second financial coverage information is determined to be different from the first financial coverage information.

9. The computer-implemented method of claim 8, wherein the switch provider computer delivers a second message to the pharmacy computer indicative of the second financial coverage information being different from the first financial coverage information.

10. The computer-implemented method of claim 1, wherein the pre-fill prescription claim request is received by the switch provider computer in accordance with a determination that the customer is likely to request a refill of the prescribed drug or product from the pharmacy within a second period of time.

11. A system, comprising:

at least one memory of at least one switch provider computer that stores computer-executable instructions; and

at least one computer processor of the at least one switch provider computer configured to access the at least one memory, wherein the at least one computer processor of the at least one switch provider computer is further configured to execute the computer-executable instructions to;

receive a pre-fill prescription claim request from a pharmacy computer, wherein the pre-fill prescription claim request identifies a prescribed drug or product for a customer, wherein the pre-fill prescription claim request is based upon anticipating a fill or refill need by the customer for the prescribed drug or product prior to receiving an actual request by the customer to fill or refill the prescribed drug or product,

deliver the pre-fill prescription claim request to a claims processor for a first adjudication,

receive, in accordance with the first adjudication, a first approved response from the claims processor for the pre-fill prescription claim request, wherein the first approved response includes first financial coverage information,

deliver the first approved response to the pharmacy computer, wherein in accordance with the delivered first approved response, a prescription order of the drug or product is prepared for pickup by the customer, wherein the prepared prescription order is labeled in accordance with the first financial coverage information,

responsive to the first approved response, automatically deliver a prescription claim reversal request to the claims processor for a second adjudication, and

receive, in accordance with the second adjudication, a second approved response that indicates a reversal of the pre-fill prescription claim request by the claims processor, wherein the prepared prescription order of the drug or product remains ready for pickup by the customer for a period of time subsequent to receiving the second approved response.

12. The system of claim 11, wherein the processor is further configured to execute the computer-executable instructions to:

receive, in accordance with a customer pickup of the prepared prescription order, a second prescription claim request from the pharmacy computer, wherein the second prescription claim request identifies the prescribed drug or product;

deliver the second prescription claim request to the claims processor for a third adjudication;

receive, in accordance with the third adjudication, a third approved response from the claims processor, wherein the third approved response includes second financial coverage information; and

deliver the third approved response to the pharmacy computer.

13. The system of claim 12, wherein the second financial coverage information is determined to be different than the first financial coverage information, and wherein the prepared prescription order is relabeled in accordance with the second financial coverage information prior to delivery to the customer.

14. The system of claim 13, wherein the pharmacy computer determines that the second financial coverage information is different from the first financial coverage information.

15. The system of claim 13, wherein the processor is further configured to execute the computer-executable instructions to:

deliver a message indicating a difference between the second financial coverage information and the first financial coverage information to the pharmacy computer, wherein the prepared prescription order is relabeled in accordance with the delivered message.

16. The system of claim 11, wherein the processor is further configured to execute the computer-executable instructions to:

deliver a pick-up message from the pharmacy computer, wherein the pick-up message indicates that the prepared prescription order has been picked up by the customer;

identify, based upon information in the pick-up message, the previously received pre-fill prescription claim request;

generate, based upon information in the pre-fill prescription claim request, a second prescription claim request;

deliver the second prescription claim request to the claims processor for a third adjudication; and

receive, in accordance with the third adjudication, a third approved response from the claims processor for the second prescription claim request, wherein the third approved response includes second financial coverage information.

17. The system of claim 16, wherein the processor is further configured to execute the computer-executable instructions to:

determine that the second financial coverage information matches the first financial coverage information; and

deliver a second message to the pharmacy computer, wherein the second message is indicative of the second financial coverage information matching the first financial coverage information.

18. The system of claim 16, wherein the second financial coverage information is determined to be different from the first financial coverage information.

19. The system of claim 18, wherein the processor is further configured to execute the computer-executable instructions to:

deliver a second message to the pharmacy computer indicative of the second financial coverage information being different from the first financial coverage information.

20. The system of claim 11, wherein the pre-fill prescription claim request is received in accordance with a determination that the customer is likely to request a refill of the prescribed drug or product from the pharmacy within a second period of time.