Systems and methods for managing and/or administering prescription benefits

• US 8,290,790 B1
• Filed: 09/01/2006
• Issued: 10/16/2012
• Est. Priority Date: 09/01/2005
• Status: Active Grant

• Current Assignee: Express Scripts Strategic Development, Inc. (The Cigna Group)
• Original Assignee: Medco Health Solutions Incorporated (The Cigna Group)
• Inventors: Jackson, William J., Ecksein, Yehuda
• Primary Examiner(s): Nguyen, Hiep V
• Application Number:
  US11/515,122
• Time in Patent Office: 2,237 Days
• Field of Search: 705/3
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

Systems and methods for allowing a user (e.g., a benefits administrator) to maintain and modify a contract or a group for a prescription drug plan may be provided. In response to receiving a request to modify a contract or a group, a prescription benefits management application may retrieve data relating to the contract or group and allow the user to input information relating to the contract or group, input broker information, input billing information, select a pharmacy network, select pricing options for the prescription plan, create a customized prescription plan, input brand/generic difference overrides, etc. In some embodiments, the modifications and/or additions made to a contract or group may be transmitted to a pharmacist, thereby allowing the pharmacist to fill one or more prescriptions in real-time or upon updating the system (e.g., within 48 to 72 hours).

Claims

1. A computer-implemented method for administering prescription drug benefits implemented by a pharmaceutical benefits management computer system, the method comprising at least one of the sequential, non-sequential and sequence independent steps of:

electronically receiving by the pharmaceutical benefits management computer system a request from a user computing device to access an account for a client administering prescription drug benefits for a plurality of members responsive to a prescription drug plan, wherein the account comprises one or more contracts;

storing account information in a computer database accessible to the pharmaceutical benefits management computer system;

in response to receiving the request, electronically transmitting by the pharmaceutical benefits management computer system to the user computing device the account information, wherein the account information comprises information relating to each contract;

receiving a request from the user computing device to add a new contract associated with the client to the account;

in response to receiving the request, providing the user computing device with an opportunity to input information relating to the new contract associated with a client, wherein the information relating to the new contract comprises first information relating to prescription benefits and coverage, second information relating to a broker, and third information relating to billing; and

processing by the pharmaceutical benefits management computer system the information received from the user computing device comprising the first information relating to the prescription benefits and coverage, the second information relating to a broker, and the third information relating to billing;

transmitting a notification of the inputted information relating to the new contract to a user at a second user computing device; and

automatically generating by the pharmaceutical benefits management computer system the new contract and generating a contract summary for display on the user computing device.

2. The method of claim 1, further comprising transmitting the information relating to prescription benefits and coverage using the Internet.

3. The method of claim 1, further comprising associating, by at least one of the system and the user computing device, the broker with the new contract.

4. The method of claim 1, further comprising determining where to deliver invoices relating to prescription benefits and coverage.

5. The method of claim 1, further comprising adding one or more groups to the new contract.

6. The method of claim 5, wherein the adding one or more groups to the new contract further comprises adding the one or more groups comprising at least two clients subscribed to the same prescription drug plan.

7. The method of claim 1, further comprising adding one or more benefits to the new contract.

8. A computer-implemented method for allowing a user to manage prescription drug benefits using a pharmaceutical benefits management computer system, the method comprising at least one of the sequential, non-sequential and sequence independent steps of:

electronically receiving by the pharmaceutical benefits management computer system a request from a user computing device to access an account for a client administering prescription drug benefits for a plurality of members responsive to a prescription drug plan, wherein the account comprises one or more contracts and wherein each contract includes one or more group members;

storing account information in a computer storage medium accessible to the pharmaceutical benefits management computer system;

in response to receiving the request, electronically transmitting by the pharmaceutical benefits management computer system to the user computing device the account information, wherein the account information comprises information relating to each contract;

receiving a request from the user computing device to add a new group member associated with at least one of the contracts or a new contract associated with the client;

in response to receiving the request, inputting information relating to the group member, wherein the information relating to the group member comprises at least one of information relating to a type of prescription program, pharmacy network, pricing options, co-payments, prescription overrides, deductibles, drug plan, and prescription benefits and coverage;

transmitting a notification of the inputted information relating to the new group member to a user at a second user computing device; and

automatically generating a group comprising at least the group member and generating a group summary for display on the user computing device.

9. The method of claim 8, further comprising generating a customized drug plan.

10. The method of claim 8, further comprising determining at least one of a plurality of generic prescription drugs and a plurality of brand prescription drugs to include in a customized drug plan.

11. The method of claim 8, further comprising transmitting the customized drug plan to the group member.

12. The method of claim 8, further comprising transmitting a prescription card to the group member.

13. The method of claim 8, further comprising indicating to the user computing device that a prescription card is available for the group member.

14. The method of claim 8, further comprising allowing a physician to input difference overrides for a user selection related to the characteristics of a prescription drug plan for a member or group.

15. The method of claim 8, further comprising allowing the user at the user computing device to select a pharmacy network for the group member.

16. The method of claim 8, further comprising automatically transmitting a notification to a pharmacist at another user computing device of the addition of the new group member associated with the at least one of contracts or new contract.

17. A computer-implemented method for allowing a user to manage prescription drug benefits using a pharmaceutical benefits management computer system, the method comprising at least one of the sequential, non-sequential and sequence independent steps of:

electronically receiving by the pharmaceutical benefits management computer system a request from a user computing device to access an account for a client administering prescription drug benefits for a plurality of members responsive to a prescription drug plan, wherein the account comprises one or more contracts and wherein each contract includes one or more group members;

storing account information in a computer database accessible to the pharmaceutical benefits management computer system;

in response to receiving the request, electronically transmitting by the pharmaceutical benefits management computer system to the user computing device the account information, wherein the account information comprises information relating to each contract;

receiving a request from the user computing device to add a new contract associated with the client;

in response to receiving the request, providing the user computing device with an opportunity to input information relating to the new contract, wherein the information relating to the new contract comprises first information relating to prescription benefits and coverage, second information relating to a broker, and third information relating to billing;

receiving a request from the user computing device to modify a group member associated with at least one of an existing contract or a new contract;

in response to receiving the request, providing the user computing device with an opportunity to input information relating to the group member, wherein the information relating to the group member comprises information relating to a type of prescription program, a pharmacy network, pricing options, co-payments, prescription overrides, deductibles, drug plan, and prescription benefits and coverage;

automatically transmitting a notification to a pharmacist at another user computing device of the modification to the group member;

receiving a request from the user computing device of the pharmacist to access the contract of the group member;

in response to receiving the request, transmitting the information relating to the group member to the user computing device of the pharmacist;

allowing the pharmacist to fill one or more prescriptions for the group member using the transmitted information; and

processing by the pharmaceutical benefits management computer system the information received form the user computing device comprising the first information relating to the prescription benefits and coverage, the second information relating to a the broker, and the third information relating to billing, and automatically generating by the pharmaceutical benefits management computer system the new contract and generating a contract summary for display on the user computing device.

18. The method of claim 17, further comprising adding a plurality of pharmacy networks by the prescription benefits management system in accordance with a user'"'"'s request, and receiving from the user a selection of a pharmacy network for the group member from the plurality of pharmacy networks responsive to the rules associated with the group.

19. The method of claim 18, further comprising receiving from a physician difference overrides to override a user selection related to the characteristics of a prescription drug plan for a member or group.

20. The method of claim 18, further comprising receiving from the user computing device a selection of a pharmacy network for the group member.

21. The method of claim 17, wherein the transmitting the notification to the pharmacist further comprises transmitting at least one of information regarding a requested drug, a notification of the member'"'"'s coverage relative to the requested drug or warning information associated with the requested drug.

22. A computer-implemented method for allowing a user to manage prescription drug benefits using a pharmaceutical benefits management computer system for third party prescription benefits administrators, prescription benefits health plans, and prescription benefit broker-direct markets for web-based transmission of prescription benefit and coverage information for at least one of new contracts and groups, the method comprising at least one of the sequential, non-sequential and sequence independent steps of:

electronically receiving by the pharmaceutical benefits management computer system a request from a user computing device to access an account for a client administering prescription drug benefits for a plurality of members responsive to a prescription drug plan, wherein the account comprises one or more contracts and wherein each contract includes one or more group members;

storing account information in a computer accessible to the pharmaceutical benefits management computer system;

in response to receiving the request, electronically transmitting by the pharmaceutical benefits management computer system to the user computing device the account information, wherein the account information comprises information relating to each contract;

receiving a request from the user computing device to add a group member to one of the contracts;

in response to receiving the request, providing the user computing device with an opportunity to input information relating to the group member, wherein the information relating to the group member comprises information relating to a type of prescription program, a pharmacy network, pricing options, co-payments, prescription overrides, deductibles, drug plan, and prescription benefits and coverage;

automatically transmitting a notification to a pharmacist at another user computing device of the modification to the group member;

receiving a request from the user computing device of the pharmacist to access the contract of the group member;

in response to receiving the request, transmitting the information relating to the group member for filling one or more prescriptions for the group member using the transmitted information;

receiving and processing additional requests, including performing the following application functionality;

searching for at least one of contract and group records;

listing contracts;

listing groups;

adding contracts;

adding groups;

adding group benefit choices;

adding group drug plan coverages;

adding group copays;

adding group pricing;

administering contracts;

administering group benefit choices;

administering drug categories;

administering copay;

administering contract and group summary information;

administering on line help information;

administering audit trail information;

terminating the contract;

terminating the group; and

administering user roles supported;

receiving and processing additional requests, including performing the following additional application functionality;

adding and maintaining a client name and primary information;

adding broker involvement and contact information;

determining billing, responsibility to pay the at least one of the prescription benefits manager, the sponsor and the administrator and where to send the invoices;

administering a group name and primary information;

selecting and maintaining program type of prescription coverage, including mail order, retail, and both mail order and retail;

selecting pharmacy network including networks of retail pharmacies contracted by the at least one of the prescription benefits manager, sponsor and administrator;

selecting and determining pricing options including how prescription claims will be priced at point of sale;

setting up and administering member co-payments and co-insurance;

setting up and administering brand and generic difference overrides based on physician DAW;

adding and determining deductible, cost CAP, and Out Of Pocket (OOP) limitations;

selecting and determining Prescription Drug Coverage (Drug Plan) and days supply coverage for program type;

setting up and administering dependent coverage;

setting up and administering general benefits including overrides of specific benefit plan rules at point of sale; and

automatically creating summary documents containing the users'"'"' selections for adding a contract, a group, and group benefits.

23. A system for administering prescription drug benefits, using a prescription benefit management system for a plurality of prescription benefit selections offered by at least one prescription benefit provider and administered by at least one prescription benefit administrator performed by at least a user of the prescription benefit administrator, comprising:

a prescription benefits management system for a plurality of prescription benefit selections offered by at least one prescription benefit provider and administered by at least one prescription benefit administrator, storing case records containing information regarding patients and prescription coverage activities for the patient;

a communication device operatively coupled to said prescription benefits management system for providing access to said prescription benefits management system over one or more electronic communication networks; and

a user computing device for accessing said prescription benefits management system from a remote location via said one or more electronic communication networks;

said prescription benefits management system being configured to;

access an account, wherein the account comprises one or more contracts;

in response to receiving the request, providing the user computing device with account information, wherein the account information comprises information relating to each contract;

receiving a request from the user computing device to add a new contract to the account for a client administering prescription drug benefits for a plurality of members responsive to a prescription drug plan;

in response to receiving the request, providing the user computing device with an opportunity to input information relating to the new contract, wherein the information relating to the new contract comprises first information relating to prescription benefits and coverage, second information relating to a broker, and third information relating to billing; and

automatically generating the new contract and generating a contract summary for display on the user computing device.

24. The system of claim 23, wherein said prescription benefits management system transmits the information relating to prescription benefits and coverage using the Internet.

25. The system of claim 23, wherein said prescription benefits management system associates, by at least one of the system and the user computing device, the broker with the new contract.

26. The system of claim 23, wherein said prescription benefits management system determines where to deliver invoices relating to prescription benefits and coverage.

27. The system of claim 23, wherein said prescription benefits management system adds one or more groups to the new contract.

28. The system of claim 23, wherein said prescription benefits management system adds one or more benefits to the new contract.

29. A system for administering prescription drug benefits, using a prescription benefit management system for a plurality of prescription benefit selections offered by at least one prescription benefit provider and administered by at least one prescription benefit administrator performed by at least a user of the prescription benefit administrator, comprising:

a prescription benefits management system for a plurality of prescription benefit selections offered by at least one prescription benefit provider and administered by at least one prescription benefit administrator, storing case records containing information regarding patients and prescription coverage activities for the patient;

a communication device operatively coupled to said prescription benefits management system for providing access to said prescription benefits management system over one or more electronic communication networks; and

a user computing device for accessing said prescription benefits management system from a remote location via said one or more electronic communication networks;

said prescription benefits management system being configured to;

receive a request from the user computing device to access an account for a client administering prescription drug benefits for a plurality of members responsive to a prescription drug plan, wherein the account comprises one or more contracts and wherein each contract includes one or more group members;

in response to receiving the request, provide the user computing device with account information, wherein the account information comprises information relating to each contract;

receive a request from the user computing device to add a new contract associated with the client to the account;

receive a request from the user computing device to add a new group member associated with at least one of the contracts or a new contract;

in response to receiving the request, input information relating to the group member, wherein the information relating to the new contract comprises at least one of information relating to a type of prescription program, pharmacy network, pricing options, co-payments, prescription overrides, deductibles, drug plan, and prescription benefits and coverage; and

automatically generate a group comprising at least the group member and generating a group summary for display on the user computing device.

30. The system of claim 29, wherein said prescription benefits management system generates a customized drug plan.

31. The system of claim 29, wherein said prescription benefits management system determines at least one of a plurality of generic prescription drugs and a plurality of brand prescription drugs to include in a customized drug plan.

32. The system of claim 29, wherein said prescription benefits management system transmits the customized drug plan to the group member.

33. The system of claim 29, wherein said prescription benefits management system transmits a prescription card to the group member.

34. The system of claim 29, wherein said prescription benefits management system indicates to the user computing device that a prescription card is available for the group member.

35. The system of claim 29, wherein said prescription benefits management system enables a physician to input difference overrides for each drug in a drug plan.

36. The system of claim 29, wherein said prescription benefits management system enables the user at the user computing device to select a pharmacy network for the group member.

37. A system for administering prescription drug benefits, using a prescription benefit management system for a plurality of prescription benefit selections offered by at least one prescription benefit provider and administered by at least one prescription benefit administrator performed by at least a user of the prescription benefit administrator, comprising:

prescription benefits management means for a plurality of prescription benefit selections offered by at least one prescription benefit provider and administered by at least one prescription benefit administrator, storing case records containing information regarding patients and prescription coverage activities for the patient;

communication means for providing access to said prescription benefits management means over one or more electronic communication networks; and

user device means for accessing said prescription benefits management means from a remote location via said one or more electronic communication networks;

said prescription benefits management means for;

accessing an account for a client administering prescription drug benefits for a plurality of members responsive to a prescription drug plan, wherein the account comprises one or more contracts;

in response to receiving the request, providing the user device means with account information, wherein the account information comprises information relating to each contract;

receiving a request from the user device means to add a new contract associated with the client to the account;

in response to receiving the request, providing the user device means with an opportunity to input information relating to the new contract, wherein the information relating to the new contract comprises first information relating to prescription benefits and coverage, second information relating to a broker, and third information relating to billing; and

automatically generating the new contract and generating a contract summary for display on the user device means.

38. A system for at least one of managing and administering prescription drug benefits, using a prescription benefit management system for a plurality of prescription benefit selections offered by at least one prescription benefit provider and administered by at least one prescription benefit administrator performed by at least a user of the prescription benefit administrator, comprising:

prescription benefits management means for a plurality of prescription benefit selections offered by at least one prescription benefit provider and administered by at least one prescription benefit administrator, storing case records containing information regarding patients and prescription coverage activities for the patient;

communication device means for providing access to said prescription benefits management means over one or more electronic communication networks; and

a user device means for accessing said prescription benefits management means from a remote location via said one or more electronic communication networks;

said prescription benefits management means for;

receiving a request from the user device means to access an account for a client administering prescription drug benefits for a plurality of members responsive to a prescription drug plan, wherein the account comprises one or more contracts and wherein each contract includes one or more group members;

in response to receiving the request, providing the user device means with account information, wherein the account information comprises information relating to each contract;

receiving a request from the user device means to add a new group member associated with at least one of the contracts or a new contract associated with the client;

in response to receiving the request, inputting information relating to the group member, wherein the information relating to the group member comprises at least one of information relating to a type of prescription program, pharmacy network, pricing options, co-payments, prescription overrides, deductibles, drug plan, and prescription benefits and coverage; and

automatically generating a group comprising at least the group member and generating a group summary for display on the user device means.