Systems and methods for monitoring controlled substance distribution

• US 8,725,532 B1
• Filed: 06/29/2012
• Issued: 05/13/2014
• Est. Priority Date: 06/29/2012
• Status: Active Grant

• Current Assignee: McKesson Corp.
• Original Assignee: Mckesson Financial Holdings Limited (McKesson Corp.)
• Inventors: Ringold, James Morgan
• Primary Examiner(s): Pauls, John
• Assistant Examiner(s): Tiedeman, Jason
• Application Number:
  US13/538,377
• Time in Patent Office: 683 Days
• Field of Search: 705/2, 705/3
• US Class Current: 705/2
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

Systems and methods for monitoring controlled substance distribution include receiving a healthcare transaction at a service provider computer. The healthcare transaction may be parsed to determine the healthcare provider submitting the healthcare transaction, the drug being prescribed as part of the healthcare transaction and the class of controlled substance to which the drug being prescribed belongs. Counters associated with total scripts prescribed by the healthcare provider and the class of controlled substance may be incremented upward in view of the healthcare transaction being approved by a claims processor. A current percentage of the class of controlled substances being prescribed can be calculated for the healthcare provider and compared to a threshold percentage for the particular class of controlled substance. If the current percentage violates the threshold percentage, a notification can be sent to a corporate level or management level for the healthcare provider for review.

Claims

1. A computer-implemented method, comprising:

receiving, from a healthcare provider computer associated with a healthcare provider, a healthcare transaction comprising one or more prescriptions for a patient, the one or more prescriptions comprising at least one controlled substance;

determining, based at least in part on information included in the healthcare transaction, a class of controlled substance to which each controlled substance identified in the healthcare transaction belongs, wherein the class of controlled substance is one of Schedule I, II, III, or IV, as defined by the U.S. Food and Drug Administration;

determining a current percentage of distribution by the healthcare provider for the class of controlled substance being prescribed by dividing a number of prescriptions issued for each class of controlled substance over a predetermined amount of time by a total number of prescriptions issued by the healthcare provider over the predetermined amount of time;

comparing the current percentage of distribution to a predetermined threshold percentage of distribution for the class of controlled substance being prescribed;

determining if the current percentage violates the predetermined threshold percentage of distribution for the class of controlled substance being prescribed; and

transmitting a notification to the healthcare provider based on a positive determination that the current percentage violates the predetermined threshold percentage,

wherein the above operations are performed by one or more computers associated with a service provider.

2. The computer-implemented method of claim 1, wherein the current percentage violates the predetermined threshold percentage if the current percentage is greater than the predetermined threshold percentage.

3. The computer-implemented method of claim 1, wherein the current percentage violates the predetermined threshold percentage if the current percentage is greater than or equal to the predetermined threshold percentage.

4. The computer-implemented method of claim 1 further comprising the step of determining for the healthcare provider with one or more computers associated with a service provider a predetermined threshold percentage for each of a plurality of classes of controlled substances.

5. The computer-implemented method of claim 4, wherein determining for the healthcare provider the predetermined threshold percentage for each of a plurality of classes of controlled substances comprises the steps of:

receiving a plurality of historical healthcare transaction data for the healthcare provider for a first predetermined amount of time;

determining, based at least in part on information included in the historical healthcare transaction data, a total number of prescriptions filled by the healthcare provider during the first predetermined amount of time;

determining for each of a plurality of classes of controlled substances, based at least in part on information included in the historical healthcare transaction data, a number of class prescriptions filled by the healthcare provider during the first predetermined amount of time; and

calculating for each of the plurality of classes of controlled substances, the predetermined threshold percentage.

6. The computer implemented method of claim 5, wherein calculating for each of the plurality of classes of controlled substances, the predetermined threshold percentage comprises the steps of:

calculating an average number total number of prescriptions filled by the healthcare provider during a second predetermined amount of time;

calculating for each of the plurality of classes of controlled substances, an average number of class prescriptions filled by the healthcare provider during the second predetermined amount of time; and

calculating for each of the plurality of classes of controlled substances the predetermined threshold percentage by dividing the average number of class prescriptions filled by the average number total prescriptions filled by the healthcare provider,

wherein the above operations are performed by one or more computers associated with a service provider.

7. The computer-implemented method of claim 6, wherein the second predetermined amount of time is a subset of the first predetermined amount of time.

8. The computer-implemented method of claim 1, wherein determining a current percentage of distribution by the healthcare provider for the class of controlled substance being provided comprises the steps of:

incrementing a total prescription count by one for the healthcare provider;

incrementing a controlled class count by one for the class of controlled substance for the healthcare provider; and

calculating the current percentage by dividing the controlled class count for the class of controlled substance by the total prescription count.

9. The computer-implemented method of claim 8, further comprising the steps of:

receiving from a claims processor computer a claim response status for the healthcare transaction;

determining, at least in part from the claim response status for the healthcare transaction, if the healthcare transaction has been approved; and

incrementing the total prescription count based on a positive determination that the healthcare transaction has been approved.

10. The computer-implemented method of claim 1, wherein the notification comprises:

an identifier for the healthcare provider;

the class of controlled substance for which the predetermined threshold percentage has been violated;

the current percentage of distribution for the class of controlled substance for the healthcare provider; and

the predetermined threshold percentage for the class of controlled substance for the healthcare provider.

11. The computer-implemented method of claim 1, wherein transmitting the notification to the healthcare provider comprises:

determining a healthcare provider back office computer associated with the healthcare provider; and

transmitting the notification to the healthcare provider back office computer.

12. A system, comprising;

at least one memory operable to store computer-executable instructions; and

at least one processor configured to access the at least one memory and execute the computer-executable instructions to;

receive, from a healthcare provider computer associated with a healthcare provider, a healthcare transaction comprising one or more prescriptions for a patient, the one or more prescriptions comprising at least one controlled substance;

determine, based at least in part on information included in the healthcare transaction, a class of controlled substance to which each controlled substance identified in the healthcare transaction belongs, wherein the class of controlled substance is one of Schedule I, II, III, or IV, as defined by the U.S. Food and Drug Administration;

determine a current percentage of distribution by the healthcare provider for the class of controlled substance being prescribed by dividing a number of prescriptions issued for each class of controlled substance over a predetermined amount of time by a total number of prescriptions issued by the healthcare provider over the predetermined amount of time;

compare the current percentage of distribution to a predetermined threshold percentage of distribution for the class of controlled substance being prescribed;

determine if the current percentage violates the predetermined threshold percentage of distribution for the class of controlled substance being prescribed; and

direct the communication of a notification to the healthcare provider computer based on a positive determination that the current percentage violates the predetermined threshold percentage.

13. The system of claim 12, wherein the at least one processor is further configured to determine for the healthcare provider a predetermined threshold percentage for each of a plurality of classes of controlled substances.

14. The system of claim 13, wherein the at least one processor is further configured to determine for the healthcare provider a predetermined threshold percentage for each of a plurality of classes of controlled substances by executing computer-executable instructions to:

receive a plurality of historical healthcare transaction data for the healthcare provider for a first predetermined amount of time;

determine, based at least in part on information included in the historical healthcare transaction data, a total number of prescriptions filled by the healthcare provider during the first predetermined amount of time;

determine for each of a plurality of classes of controlled substances, based at least in part on information included in the historical healthcare transaction data, a number of class prescriptions filled by the healthcare provider during the first predetermined amount of time; and

calculate for each of the plurality of classes of controlled substances, the predetermined threshold percentage.

15. The system of claim 14, wherein the at least one processor is configured to calculate for each of the plurality of classes of controlled substances, the predetermined threshold percentage by accessing the at least one memory and executing computer-executable instructions to:

calculate an average total number of prescriptions filled by the healthcare provider during a second predetermined amount of time;

calculate for each of the plurality of classes of controlled substances, an average number of class prescriptions filled by the healthcare provider during the second predetermined amount of time; and

calculate for each of the plurality of classes of controlled substances the predetermined threshold percentage by dividing the average number of class prescriptions filled by the average number total prescriptions filled by the healthcare provider.

16. The system of claim 12, wherein the at least one processor is configured to determine a current percentage of distribution by the healthcare provider for the class of controlled substance being provided by accessing the at least one memory and executing computer-executable instructions to:

increment a total prescriptions count by one for the healthcare provider;

increment a controlled class count by one for the class of controlled substance for the healthcare provider; and

calculate the current percentage by dividing the controlled class count for the class of controlled substance by the total prescriptions count.

17. The system of claim 12, wherein the at least one processor is configured to direct the communication of the notification to the healthcare provider by accessing the at least one memory and executing computer-executable instructions to:

determine a healthcare provider back office computer associated with the healthcare provider; and

direct communication of the notification to the healthcare provider back office computer.

18. The system of claim 12, wherein the current percentage violates the predetermined threshold percentage if the current percentage is greater than the predetermined threshold percentage.

19. The system of claim 12, wherein the current percentage violates the predetermined threshold percentage if the current percentage is greater than or equal to the predetermined threshold percentage.

20. The system of claim 12, wherein the notification comprises:

an identifier for the healthcare provider;

the class of controlled substance for which the predetermined threshold percentage has been violated;

the current percentage of distribution for the class of controlled substance for the healthcare provider; and

the predetermined threshold percentage for the class of controlled substance for the healthcare provider.