MEDICARE PHARMACY CALCULATOR II

• US 20080021736A1
• Filed: 10/09/2007
• Published: 01/24/2008
• Est. Priority Date: 05/12/2005
• Status: Active Grant

• Current Assignee: Humana Incorporated
• Original Assignee: Humana Incorporated
• Inventors: Townsend, David, Elizabeth, Megan, Marco, Stephen, Muse, Mark, Loehr, Jason, Iyengar, Srinath, Augspurger, Kristen, Stephens, Sarah
• Granted Patent: US 7,860,732 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G06Q 50/00 Information and communication technology [ICT] specially adapted for implementation of business processes of specific business sectors, e.g. utilities or tourism healthcare informatics G16H

Abstract

A method and apparatus for providing a Medicare Part D Pharmacy Benefits Calculator. A user inputs data for prescriptions to be purchased by a prospective insured for a plan period. The prescription data includes a quantity, a days supply, and a number of fills. The data for each prescription the user enters is used to calculate anticipated out-of-pocket costs for the prescriptions for one or more pharmacy benefits plans available to the prospective insured. The cost data is presented to the user in a way that illustrates how out-of-pocket costs will vary over the course of a plan period. The user may view costs for alternative drugs and alternatives sources of drugs. The user may vary and expand the presentation of the cost data to better understand the available plan benefits. The invention helps prospective insureds decide among alternative Medicare Part D pharmacy benefits plans offered by one or more insurance companies.

Claims

1. A method for calculating and displaying anticipated out-of-pocket pharmacy costs to a user under at least one Medicare Part D pharmacy benefit plan, comprising:

a) receiving from said user prescription data for a plurality of drugs, said prescription data comprising a drug identifier, a number of doses, a number of days supply, and a number of fills during a plan period;

b) assigning a drug fill for each fill of said plurality of drugs to a month in which said drug fill will be purchased during said plan period wherein said assignments are made according to said number of doses for said drug, said number of days supply for said drug, and said number of fills for said drug;

c) calculating an anticipated out-of-pocket cost for each drug fill according to said assignments of each fill of said plurality of drugs to a month in which each drug fill will be purchased during said plan period wherein calculating an anticipated out-of-pocket cost comprises;

i. determining a cost for said drug fill under said at least one Medicare Part D pharmacy benefit plan;

ii. determining if at least one Medicare Part D stage is applicable to said drug fill;

iii. determining out-of-pocket costs for said drug fill according to each Medicare Part D stage applicable to said drug fill as determined in step ii and said cost for said drug fill under said at least one Medicare Part D pharmacy benefit plan;

iv. repeating steps i-iii for each drug fill; and

d) presenting to said user anticipated out-of-pocket costs for said plan period by presenting a monthly anticipated out-of-pocket cost for each applicable month of said plan period wherein said monthly anticipated out-of-pocket cost is determined according to said assignments of each drug fill for each of said plurality of drugs to a month in which said drug fill will be purchased during said plan period.

2. The method of claim 1 wherein assigning a drug fill for each fill of said plurality of drugs to a month comprises assigning a drug fill to a month according to an order in which said prescription data for said plurality of drugs is received from said user.

3. The method of claim 2 further comprising:

e) receiving from said user said prescription data for said plurality of drugs according to a new order;

f) assigning a drug fill for each fill of said plurality of drugs to a month in which said drug will be purchased during said plan period wherein said assignments are made according to said number of doses for said drug, said number of days supply for said drug, said number of fills for said drug, and said new order;

g) calculating a new anticipated out-of-pocket cost for said user by calculating an anticipated out-of-pocket cost for each drug fill according to said assignments of each of said plurality of drug fills to a month in said new order; and

h) presenting said total anticipated out-of-pocket cost by presenting to said user a monthly anticipated out-of-pocket cost organized according to said changed assignments of each of said plurality of drugs to a month in which said drug fill will be filled during said plan period.

4. The method of claim 1 further comprising:

e) presenting to said user an indication of at least one Medicare Part D stage applicable to said monthly anticipated out-of-pocket cost.

5. The method of claim 4 wherein:

f) presenting to said user an indication of at least one Medicare Part D stage applicable to said monthly anticipated out-of-pocket cost comprises presenting to said user an indication of at least one Medicare Part D stage applicable to one of said drug fills.

6. The method of claim 1 wherein said plan period is one year.

7. The method of claim 1 further comprising:

e) receiving from said user pharmacy provider information for each of said plurality of drugs; and

f) using said pharmacy provider information when determining a cost for each of said plurality of drugs under said at least one Medicare Part D pharmacy benefit plan.

8. The method of claim 1 further comprising:

e) calculating anticipated out-of-pocket costs for a second Medicare Part D pharmacy benefit plan; and

f) presenting to said user a comparison of anticipated out-of-pocket costs for said Medicare Part D pharmacy benefit plan and said second Medicare Part D pharmacy benefit plan, where applicable.

9. A method for calculating and displaying anticipated out-of-pocket pharmacy costs to a user under at least one Medicare Part D pharmacy benefit plan, comprising:

a) receiving from said user prescription data for a plurality of drugs, said prescription data comprising a drug identifier, a number of doses, a number of days supply, and a number of fills during a plan period;

b) assigning a drug fill for each fill of said plurality of drugs to a month in which said drug fill will be purchased during said plan period wherein said assignments are made according to said number of doses for said drug, said number of days supply for said drug, and said number of fills for said drug;

c) calculating an anticipated out-of-pocket cost for each drug fill according to said assignments of each fill of said plurality of drugs to a month in which each drug fill will be purchased during said plan period by determining out-of-pocket costs for each said drug fill according to applicable Medicare Part D stages and a cost for said drug fill under said at least one Medicare Part D pharmacy benefit plan;

d) calculating a monthly total anticipated out-of-pocket cost for each month of said plan period by summing for each month of said plan period an anticipated out-of-pocket cost for each drug fill according to said assignments of each fill of said plurality of drugs to a month in which each drug fill will be purchased during said plan period;

e) presenting to said user a list comprising a month, an anticipated out-of-pocket cost for said month, and a Medicare Part D stage applicable to said month for applicable months of said plan period; and

f) presenting to said user in response to a request for details for a specified month a list of drug fills for said specified month, an anticipated out-of-pocket cost for each drug fill in said specified month, an indicator of at least one Medicare Part D stage applicable to said drug fills for said specified month, and a running total of out-of-pocket costs based on said out-of-pocket costs for each drug fill in said list.

10. The method of claim 9 wherein presenting to said user an indicator of at least one Medicare Part D stage applicable to said drug fills for said specified month comprises inserting a stage identifier in said list of drug fills.

11. The method of claim 9 further comprising:

g) identifying alternative drugs, if applicable, for each of said plurality of drugs received in said prescription data from said user;

h) assigning a drug fill for each fill of said plurality of alternative drugs to a month in which said alternative drug fill will be purchased during said plan period wherein said assignments are made according to said number of doses for said alternative drug, said number of days supply for said alternative drug, and said number of fills for said alternative drug;

i) calculating an anticipated out-of-pocket cost for each alternative drug fill according to said assignments of each fill of said plurality of alternative drugs to a month in which each drug fill will be purchased during said plan period by determining out-of-pocket costs for each said alternative drug fill according to at least one Medicare Part D stage applicable to said drug fill and a cost for said alternative drug fill under said at least one Medicare Part D pharmacy benefit plan;

j) calculating a monthly total anticipated out-of-pocket cost for each month of said plan period by summing for each month of said plan period an anticipated out-of-pocket cost for each alternative drug fill according to said assignments of each fill of said plurality of alternative drugs to a month in which each alternative drug fill will be purchased during said plan period; and

k) presenting to said user a list comprising a month, an anticipated out-of-pocket cost for said month based on said alternative drug fill for said month, and a Medicare Part D stage applicable to said month for all applicable months of said plan period and a benefit to said user related to purchasing said alternative drug fill.

12. The method of claim 9 further comprising:

g) identifying an alternative source for at least one of said plurality of drugs received in said prescription data from said user;

h) assigning a drug fill for each fill of said at least one of said plurality of drugs to a month in which said drug fill will be purchased during said plan period wherein said assignments are made according to said number of doses for said drug, said number of days supply for said drug, and said number of fills for said drug;

i) calculating an anticipated out-of-pocket cost for each drug fill according to said assignments of each drug fill to a month in which each drug fill will be purchased during said plan period by determining out-of-pocket costs for each said drug fill according to at least one Medicare Part D stage applicable to said drug fill and a cost for said drug fill under said at least one Medicare Part D pharmacy benefit plan determined according to said alternative source for said at least one of said plurality of drugs;

j) calculating a monthly total anticipated out-of-pocket cost for each month of said plan period by summing for each month of said plan period an anticipated out-of-pocket cost for each drug fill according to said assignments of each drug fill to a month in which each drug fill will be purchased during said plan period; and

k) presenting to said user a list comprising a month, an anticipated out-of-pocket cost for said month based on said drug fills for said month, and a Medicare Part D stage applicable to said month for all applicable months of said plan period and a benefit to said user related to purchasing said at least one drug from said alternative source.

13. The method of claim 9 further comprising:

g) presenting to said user a total out-of-pocket cost for said plan period wherein said total out-of-pocket cost is a sum of said anticipated out-of-pocket cost for each fill in each applicable month of said plan period.

14. The method of claim 9 wherein said plan period is up to one year.

15. A method for calculating and displaying anticipated out-of-pocket pharmacy costs to a user under at least one Medicare Part D pharmacy benefit plan, comprising:

a) receiving from said user prescription data for a plurality of drugs, said prescription data comprising a drug identifier, a number of doses, a number of days supply, and a number of fills during a plan period;

b) assigning a drug fill for each fill of said plurality of drugs to a month in which said drug fill will be purchased during said plan period wherein said assignments are made according to said number of doses for said drug, said number of days supply for said drug, and said number of fills for said drug;

c) calculating an anticipated out-of-pocket cost for each drug fill according to said assignments of each fill of said plurality of drugs to a month in which each drug fill will be purchased during said plan period wherein calculating an anticipated out-of-pocket cost comprises;

i. determining a cost for said drug fill under said at least one Medicare Part D pharmacy benefit plan;

ii. determining if at least one Medicare Part D stage is applicable to said drug fill;

iii. determining out-of-pocket costs for said drug fill according to each Medicare Part D stage applicable to said drug fill as determined in step ii and said cost for said drug fill under said at least one Medicare Part D pharmacy benefit plan;

iv. repeating steps i-iii for each drug fill of said plurality of drugs; and

d) presenting to said user anticipated out-of-pocket costs organized in a table comprising a listing of months for said plan period, a list of drug fills for each month, an anticipated out-of-pocket cost for each drug fill, and an indicator of a Medicare Part D stage applicable to said each drug fill for said month.

16. The method of claim 15 wherein said table further comprises a running total of out-of-pocket costs for each drug fill.

17. The method of claim 15 wherein said indicator of a Medicare Part D stage comprises an indicator for a beginning of a Medicare Part D stage.

18. The method of claim 17 wherein said indicator for a beginning of a Medicare Part D stage is identified by stage.

19. The method of claim 15 wherein said indicator of a Medicare Part D stage appears in a table cell based on anticipated out-of-pocket cost for a drug fill.

20. The method of claim 15 wherein assigning a drug fill for each fill of said plurality of drugs to a month comprises assigning a drug fill to a month according to an order in which said prescription data for said plurality of drugs is received from said user.