APPARATUS AND METHOD FOR CONSTRUCTING FORMULARIES
First Claim
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1. A method of constructing a formulary, comprising:
- (a) storing a plurality of pharmaceutical products in a computer;
(b) storing in the computer a plurality of pharmaceutical categories, wherein each pharmaceutical category comprises;
(i) a category definition based on predetermined relational characteristics shared by the plurality of pharmaceutical products;
(ii) a therapeutic description;
(c) sorting, by the computer, the plurality of pharmaceutical products into the pharmaceutical category;
(d) creating a plurality of base formularies comprising the plurality of pharmaceutical products responsive to predetermined criteria;
(e) creating a new formulary by;
(i) defining desired inclusion rules comprising criteria for accepting coverage of non-formulary pharmaceutical products when present;
(ii) selecting at least one of the preexisting base formularies when the selected base formulary'"'"'s inclusion rules are substantially similar to the desired inclusion rules;
(iii) modifying the selected base formulary when additional pharmaceutical products are present by allowing the user to select on the computer the additional pharmaceutical products to be included into the new formulary.
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Abstract
An system for constructing formularies is disclosed. The system includes a central computer system and at least one additional computer. The central computer system compiles a list of various pharmaceutical products and sort them into different categories. Formularies are then created by selecting individual products or categories of products that will be covered. When prescription claims are received, coverage is either accepted or denied based on whether the products in the prescription claims are covered by the formulary.
19 Citations
24 Claims
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1. A method of constructing a formulary, comprising:
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(a) storing a plurality of pharmaceutical products in a computer; (b) storing in the computer a plurality of pharmaceutical categories, wherein each pharmaceutical category comprises; (i) a category definition based on predetermined relational characteristics shared by the plurality of pharmaceutical products; (ii) a therapeutic description; (c) sorting, by the computer, the plurality of pharmaceutical products into the pharmaceutical category; (d) creating a plurality of base formularies comprising the plurality of pharmaceutical products responsive to predetermined criteria; (e) creating a new formulary by; (i) defining desired inclusion rules comprising criteria for accepting coverage of non-formulary pharmaceutical products when present; (ii) selecting at least one of the preexisting base formularies when the selected base formulary'"'"'s inclusion rules are substantially similar to the desired inclusion rules; (iii) modifying the selected base formulary when additional pharmaceutical products are present by allowing the user to select on the computer the additional pharmaceutical products to be included into the new formulary. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. A method of constructing a formulary, comprising:
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(a) storing a plurality of pharmaceutical products in a computer; (b) storing in the computer a plurality of pharmaceutical categories, wherein each pharmaceutical category comprises; (i) a category definition based on predetermined relational characteristics shared by the plurality of pharmaceutical products; (ii) a therapeutic description; (c) sorting, by the computer, the plurality of pharmaceutical products into the pharmaceutical category; (d) creating a plurality of base formularies, wherein each base formulary is created by; (i) selecting on the computer at least one of the sorted pharmaceutical products for inclusion in the base formulary, (ii) entering into the computer inclusion rules descriptive of the base formulary; (iii) saving the base formulary in the computer, (e) updating the list of pharmaceutical products in at least one of the plurality of base formularies at predetermined intervals to include newly released pharmaceutical products; (f) selecting additional released pharmaceutical products from the newly released pharmaceutical products to be supported by the at least one of the plurality of formularies, based at least in part on the categories; (g) receiving a prescription claim for coverage of a prescribed pharmaceutical product, (h) accepting coverage for the prescription claim based on whether the prescribed pharmaceutical product is supported by at least one of the formularies, and (i) rejecting coverage for the prescription claim based on whether the prescribed pharmaceutical product is not supported by the at least one of the formularies. - View Dependent Claims (15, 16, 17, 18, 19, 20, 21, 22, 23)
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24. A method of constructing a formulary, comprising:
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(a) storing a plurality of pharmaceutical products in a computer; (b) storing in the computer a plurality of pharmaceutical categories, wherein each pharmaceutical category comprises; (i) a category definition based on predetermined relational characteristics shared by the plurality of pharmaceutical products; (ii) a therapeutic description; (c) creating a plurality of base formularies, wherein each base formulary is created by; (i) selecting on the computer at least one of the sorted pharmaceutical products for inclusion in the base formulary, (ii) entering into the computer inclusion rules descriptive of the base formulary; (iii) saving the base formulary in the computer, (d) updating the list of pharmaceutical products in at least one of the plurality of base formularies at predetermined intervals to include newly released pharmaceutical products; (e) selecting additional released pharmaceutical products from the newly released pharmaceutical products to be supported by the at least one of the plurality of formularies, based at least in part on the categories; (f) receiving a prescription claim for coverage of a prescribed pharmaceutical product, (g) accepting coverage for the prescription claim based on whether the prescribed pharmaceutical product is supported by at least one of the formularies, and (h) rejecting coverage for the prescription claim based on whether the prescribed pharmaceutical product is not supported by the at least one of the formularies.
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Specification