Method and system for charging customers for prescription alignment

• US 8,364,503 B1
• Filed: 01/27/2010
• Issued: 01/29/2013
• Est. Priority Date: 11/21/2008
• Status: Active Grant

• Current Assignee: Walgreen Co. (Walgreens Boots Alliance Incorporated)
• Original Assignee: Walgreen Co. (Walgreens Boots Alliance Incorporated)
• Inventors: Biesenthal, Amy C., Pankow, Greg
• Primary Examiner(s): Morgan, Robert
• Assistant Examiner(s): KANAAN, MAROUN P
• Application Number:
  US12/694,974
• Time in Patent Office: 1,098 Days
• Field of Search: 705/2, 705/3
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/00 Administration; Management

Abstract

A system and method facilitate alignment of refill dates associated with a plurality of prescriptions, and determine the cost to the customer for the alignment of the plurality of prescriptions. The system may determine the cost to the customer by evaluating one or more of the number of prescriptions aligned, the types of medications prescribed by the aligned prescriptions, the quantity of medication supplied in any intermediate fills between the last adjudication date and the alignment adjudication date, the particular medications prescribed by the aligned prescriptions, and the number of prescriptions aligned. The system may also evaluate one or more rules or contracts related to one or more third-party payors in determining the cost to the customer for alignment.

Claims

1. A non-transitory computer readable storage medium having instructions stored thereon and executable by a processor to perform a method for charging a customer for a prescription alignment service, the prescription alignment service offered by a pharmacy and aligning to a single alignment date refill dates associated with a plurality of prescriptions for a customer, the method comprising:

receiving a selection of a plurality of prescriptions to align;

determining a final alignment date;

determining, for each of the plurality of selected prescriptions, whether an intermediate fill is required so that the customer does not exhaust a remaining day supply of the medication before the final alignment date;

calculating one or both of an intermediate-fill day supply and an intermediate-fill quantity for any prescription requiring an intermediate fill;

adjudicating each of the intermediate fills to determine an intermediate-fill payment amount in accordance with an agreement between the pharmacy and a third-party payor;

causing any required intermediate fill to be filled and provided to the customer, based on either the intermediate-fill quantity or the intermediate-fill day supply for the prescription; and

causing each of the selected prescriptions to be filled and charging either a customer or an insurance company for the prescription alignment service, or one or more intermediate fills, or both.

2. The computer readable medium of claim 1, wherein the intermediate-fill payment amount is proportional to the intermediate-fill day supply or the intermediate-fill quantity.

3. The computer readable medium of claim 1, wherein the intermediate-fill payment amount is determined by selecting a range into which the intermediate-fill day supply falls or by selecting a range into which the intermediate-fill quantity falls.

4. The computer readable medium of claim 1, wherein the intermediate-fill payment amount is the same as a co-payment amount for a prescribed day supply of the prescription medication.

5. The computer readable medium of claim 1, wherein determining the intermediate-fill payment amount further comprises:

determining a retail price for the intermediate fill;

determining a co-payment amount for a prescribed quantity of the prescription medication; and

selecting the lesser of the retail price and the co-payment amount.

6. The computer readable medium of claim 1, wherein determining the intermediate-fill payment amount comprises multiplying the intermediate-fill quantity by a contracted price.

7. The computer readable medium of claim 1, wherein determining the intermediate-fill payment amount comprises:

determining an intermediate-fill quantity by multiplying the intermediate-fill day supply by a dose; and

multiplying the intermediate-fill quantity by a contracted price.

8. The computer readable medium of claim 1, wherein the intermediate-fill day supply is more than a prescribed day supply, and wherein the intermediate-fill payment amount is two times a co-payment amount for a prescribed day supply of the prescription medication.

9. A non-transitory computer readable storage medium having instructions stored thereon and executable by a processor to perform a method for charging a customer for a prescription alignment service, the prescription alignment service offered by a pharmacy and aligning to a single alignment date refill dates associated with a plurality of prescriptions for a customer, the method comprising:

receiving a selection of a plurality of prescriptions to align;

determining a final alignment date;

determining, for each of the plurality of selected prescriptions, whether an intermediate fill is required so that the customer does not exhaust a remaining day supply of the medication before the final alignment date;

calculating one or both of an intermediate-fill day supply and an intermediate-fill quantity for any prescription requiring an intermediate fill;

determining an alignment fee amount;

causing any required intermediate fill to be filled and provided to the customer, based on either the intermediate-fill quantity or the intermediate-fill day supply for the prescription; and

causing each of the selected prescriptions to be filled and charging either a customer or an insurance company for the prescription alignment service, or one or more intermediate fills, or both.

10. The computer readable medium of claim 9, wherein the alignment fee amount is a fixed fee for the prescription alignment service.

11. The computer readable medium of claim 9, wherein the alignment fee is proportional to the number of prescriptions aligned by the prescription alignment service.

12. The computer readable medium of claim 9, wherein determining an alignment fee amount further comprises:

determining the number of selected prescriptions comprising brand name medications;

determining the number of selected prescriptions comprising generic medications;

calculating a brand name medication alignment fee as the product of a first fee and the number of selected prescriptions comprising brand name medications;

calculating a generic medication alignment fee as the product of a second fee and the number of selected prescriptions comprising generic medications;

summing the brand name medication alignment fee and the generic medication alignment fee to determine a total alignment fee.

13. The computer readable medium of claim 9, wherein determining an alignment fee amount further comprises:

determining an individual alignment fee for each of the selected prescriptions; and

summing the individual alignment fees,

wherein the individual alignment fee for each of the selected prescriptions is based on the prescribed medication.

14. The computer readable medium of claim 13, wherein the individual alignment fee for each of the selected prescriptions is further based on the intermediate-fill day supply for the respective selected prescription.

15. The computer readable medium of claim 9, wherein determining an alignment fee amount further comprises:

determining an individual alignment fee for each of the selected prescriptions; and

summing the individual alignment fees,

wherein the individual alignment fee for each of the selected prescriptions is based on whether the prescribed medication is a brand name medication or a generic medication.

16. A prescription management system operable to align to a single alignment date refill dates associated with a plurality of prescriptions for a customer, the system comprising:

a network;

a computer coupled to the network;

a database comprising a plurality of customer records, a plurality of third-party payor records, and a plurality of medication information records;

an alignment engine for determining parameters associated with the alignment of the plurality of prescriptions, the alignment engine comprising computer readable instructions operable to cause a processor executing the instructions to;

receive a selection a plurality of prescriptions to align;

calculate a final alignment date; and

calculate an intermediate-fill parameter; and

a cost-determination module comprising computer readable instructions operable to;

cause a processor executing the instructions to adjudicate any required intermediate fills and to determine for each an intermediate-fill payment amount in accordance with an agreement between the pharmacy and a third-party payor, and

charge for the prescription alignment service, or one or more intermediate fills, or both.

17. The system of claim 16, wherein the alignment engine further comprises computer readable instructions operable to cause a processor executing the instructions to calculate an intermediate-fill quantity for any intermediate-fill, and further wherein the intermediate-fill payment amount for each intermediate-fill is proportional to the intermediate-fill quantity.

18. The system of claim 16, wherein the alignment engine further comprises computer readable instructions operable to cause a processor executing the instructions to calculate an intermediate-fill quantity for any intermediate-fill, and further wherein the intermediate-fill payment amount is determined by selecting a range into which the intermediate-fill quantity falls.

19. The system of claim 16, wherein the intermediate-fill payment amount is the same as a co-payment amount for a prescribed day supply of the prescription medication.

20. The system of claim 16, wherein the alignment engine further comprises computer readable instructions operable to cause a processor executing the instructions to calculate an intermediate-fill quantity for any intermediate-fill, and wherein the cost determination module further comprises computer readable instructions operable to cause a processor executing the instructions to determine the intermediate-fill payment amount by multiplying the intermediate-fill quantity by a contracted price.