Systems and methods for alerting pharmacies of formulary alternatives
First Claim
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1. A method of alerting pharmacies of formulary alternatives, comprising:
- receiving, by at least one computer processor of an intermediary server in communication with a pharmacy and a payer recipient, a claim generated by the pharmacy from a pharmacy practice management system, wherein the claim comprises at least one drug, wherein the claim is directed to the payer recipient, and wherein the claim is received by the payer recipient prior to forwarding by the intermediary server any formulary alternatives to the at least one drug;
reviewing, by at least one computer processor, the claim to identify the at least one drug as a drug the payer recipient has preselected;
comparing, by at least one computer processor, the at least one drug to a pre-established formulary alternative table established, at least in part, by the payer recipient, wherein the pre-established formulary alternative table comprises one or more preferred drug alternatives based at least in part on cost differences between the at least one drug and the one or more preferred drug alternatives; and
forwarding a preferred drug alternative to the pharmacy practice management system when the at least one drug has a match in the pre-established formulary alternative table, wherein the preferred drug alternative is forwarded via an alert that can be responded to or bypassed by the pharmacy practice management system.
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Accused Products
Abstract
Methods, systems and computer program products alert pharmacies of formulary alternatives. A claim generated by a provider and including at least one drug is received, where the claim is directed to a payer recipient. The claim is reviewed to identify the at least one drug. The at least one drug is then compared to a pre-established formulary alternative table, which may be created or managed, at least in part, by the payer recipient. A preferred drug alternative may then be forwarded to the provider when the at least one drug has a match in the pre-established formulary alternative table.
216 Citations
20 Claims
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1. A method of alerting pharmacies of formulary alternatives, comprising:
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receiving, by at least one computer processor of an intermediary server in communication with a pharmacy and a payer recipient, a claim generated by the pharmacy from a pharmacy practice management system, wherein the claim comprises at least one drug, wherein the claim is directed to the payer recipient, and wherein the claim is received by the payer recipient prior to forwarding by the intermediary server any formulary alternatives to the at least one drug; reviewing, by at least one computer processor, the claim to identify the at least one drug as a drug the payer recipient has preselected; comparing, by at least one computer processor, the at least one drug to a pre-established formulary alternative table established, at least in part, by the payer recipient, wherein the pre-established formulary alternative table comprises one or more preferred drug alternatives based at least in part on cost differences between the at least one drug and the one or more preferred drug alternatives; and forwarding a preferred drug alternative to the pharmacy practice management system when the at least one drug has a match in the pre-established formulary alternative table, wherein the preferred drug alternative is forwarded via an alert that can be responded to or bypassed by the pharmacy practice management system. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9)
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10. A system of alerting pharmacies of formulary alternatives, comprising:
an intermediary server, in communication with a provider, wherein the intermediary server is operable to; receive a claim generated by a pharmacy from a pharmacy practice management system, where the claim is directed to a payer recipient, and where the claim comprises at least one drug preselected by the payer recipient, wherein the claim is received by the payer recipient prior to forwarding by the intermediary server any formulary alternatives to the at least one drug; review the claim to identify the at least one drug;
compare the at least one drug to a pre-established formulary alternative table established, at least in part, by the payer recipient, wherein the pre-established formulary alternative table comprises one or more preferred drug alternatives based at least in part on cost differences between the at least one drug and the one or more preferred drug alternatives; andforward a preferred drug alternative to the pharmacy practice management system when the at least one drug has a match in the pre-established formulary alternative table, wherein the preferred drug alternative is forwarded to the pharmacy practice management system via an alert that may be accepted or declined by the pharmacy practice management system. - View Dependent Claims (11, 12, 13, 14, 15, 16, 17, 18, 19, 20)
Specification