Method for improving pharmaceutical selection ratios in pharmacy implementation of prescription medication dispensing plans

• US 8,069,059 B2
• Filed: 03/12/2009
• Issued: 11/29/2011
• Est. Priority Date: 04/04/2006
• Status: Active Grant

• Current Assignee: Medimpact Healthcare Systems Incorporated
• Original Assignee: Medimpact Healthcare Systems Incorporated
• Inventors: Howe, Frederick, Lyon, Michael W., Barre, William J.
• Primary Examiner(s): Sereboff; Neal
• Application Number:
  US12/403,139
• Publication Number:
  US 20090177490A1
• Time in Patent Office: 992 Days
• Field of Search: 705/2, 705/3
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• CPC Class Codes: G06Q 30/0236 Incentive or reward received by requiring registration or ID from user
• CPC Class Codes: G06Q 30/0283 Price estimation or determination
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

A method is disclosed by which pharmacies and physicians are encouraged to select appropriate and effective medications but dissuaded from selecting higher priced medications where more economical versions are available as alternatives, but where physicians and patients can also select such higher priced medications if they so choose and are prepared to pay that higher price. Under this system a single representative price (capitation rate) is calculated by a prescription payment plan manager for a group of related medications, usually including both branded and generic, and that price is paid to a pharmacy for all prescriptions of that group of medications fulfilled under the plan. The representative prices for different groups, including their minimum levels, are periodically reviewed and updated as appropriate.

Claims

1. A method for improving pharmacy medication selection ratios in a prescription fulfillment plan, the method being embodied on a tangible computer readable storage media, wherein the method comprises:

a defining a group of related medications dispensed by a pharmacy under said plan, determining the sales price and group sales percentage of each medication within said group, determining therefrom a group-weighted sales price for each said medication, and performing a calculation of a representative price by summing said group-weighted sales prices for all medications within said group;

b excluding from said group and representative price calculation those related medications which have price structures dissimilar to those medications within said group;

c establishing a minimum amount at or above which said representative price will be maintained;

d for each prescription fulfillment of a medication within said group, paying to said pharmacy an amount equal to said representative price;

e periodically repeating step a; and

f periodically assessing and when appropriate adjusting said minimum amount of step c;

whereby each said pharmacy receives an incentive to preferentially fulfill said prescriptions with lower costs medications with said group when consistent with medical efficacy and prescriber instruction.

2. A method as in claim 1 wherein said representative price comprises a capitation rate on reimbursement of a pharmacy under said plan.

3. A method as in claim 1 wherein said group comprises at least one each of a branded medication and a generic medication.

4. A method as in claim 1 wherein said medications excluded from said group comprise medications which have recently been introduced to the market and medications for which the ingredient cost is substantially greater than a normal range of ingredient costs for medications within the group.

5. A method as in claim 1 wherein periodic repetition of step d occurs on a period determined by overall sales activity of the medications of said group in the marketplace.

6. A method as in claim 5 wherein said period length is on the order of two weeks.

7. A method as in claim 1 wherein said periodic assessment of step f occurs on a period length of not more than one year.

8. A method as in claim 1 further comprising defining a plurality of groups, each of which is comprised of medications of a single medical class, and conducting steps b through f independently for each group, whereby said pharmacy receives different payment of different representative prices for different groups within said plurality, each said representative price being calculated such that said pharmacy has appropriate incentive for each said group to fulfill prescriptions for medications within said group with a lower cost one of said medications.

9. A method as in claim 1 wherein data for steps a and b are contained in a database comprising medication identifications and current and historical prices and sales amounts for each medication within said database and means for implementation of said steps a. and b. comprises computer software.

10. A method as in claim 9 wherein at least said steps e and f are implemented by computer software utilizing data from said database.

11. A method as in claim 4 wherein said exclusion for a newly introduced medication expires one year following the date of its introduction to the market, and thereafter said medication is included within said group.

12. A method as in claim 4 further comprising subsequent reassessment of said exclusion of a medication which has a price structure dissimilar to those medications within said group, at such time as there may be a change in such price structure, and thereupon terminating said exclusion if such change has occurred and has been sufficient to make the then-current price structure of said medication comparable to price structures of medications already within said group.

13. A method for improving pharmacy medication selection ratios in a prescription fulfillment plan, the method being embodied on a tangible computer readable storage media, wherein the method comprises:

a defining a group of related branded and generic medications dispensed by a pharmacy under said plan, determining the sales price and group sales percentage of each medication within said group, determining therefrom a group-weighted sales price for each said medication, and performing a calculation of a representative price by summing said group-weighted sales prices for all medications within said group;

b excluding from said group and representative price calculation any recently released medication for which a stable price level has not been established;

c excluding from said group and representative price calculation any medication having an average wholesale price that exceeds a pre-determined maximum allowable cost;

d establishing a minimum representative price for said group;

e for each prescription fulfillment of a medication within said group, paying to said pharmacy an amount equal to said representative price; and

f periodically repeating steps a to e;

whereby each said pharmacy receives an incentive to preferentially fulfill said prescriptions with lower costs medications with said group when consistent with medical efficacy and prescriber instruction.

14. The method of claim 13, wherein the minimum representative price in step e is determined such that the pharmacy is provided with an incentive to dispense lower cost medications as opposed to higher cost medications.

15. The method of claim 13, wherein recently released medications in step c are medications released in the last year.

16. The method of claim 13, wherein the pre-determined maximum allowable cost in step d is $200.

17. The method of claim 13, further comprising defining a plurality of groups, each of which is comprised of medications of a single medical class, and conducting steps b through e independently for each group, whereby said pharmacy receives different payment of different representative prices for different groups within said plurality, each said representative price being calculated such that said pharmacy has appropriate incentive for each said group to fulfill prescriptions for medications within said group with a lower cost one of said medications.

18. The method of claim 13, further comprising:

g periodically repeating step d to maintain an appropriate minimum representative price for said group.