Method for improving pharmaceutical selection ratios in pharmacy implementation of prescription medication dispensing plans

• US 7,505,917 B2
• Filed: 04/04/2006
• Issued: 03/17/2009
• Est. Priority Date: 04/04/2006
• Status: Active Grant

• Current Assignee: Medimpact Healthcare Systems Incorporated
• Original Assignee: Medimpact Healthcare Systems Incorporated
• Inventors: Howe, Frederick, Lyon, Michael W., Barre, William J.
• Primary Examiner(s): Gilligan; C Luke
• Assistant Examiner(s): SEREBOFF, NEAL
• Application Number:
  US11/397,928
• Publication Number:
  US 20070233516A1
• Time in Patent Office: 1,078 Days
• Field of Search: 705/2
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• CPC Class Codes: G06Q 30/0236 Incentive or reward received by requiring registration or ID from user
• CPC Class Codes: G06Q 30/0283 Price estimation or determination
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

A method is disclosed by which pharmacies and physicians are encouraged to select appropriate and effective medications but dissuaded from selecting higher priced medications where more economical versions are available as alternatives, but where physicians and patients can also select such higher priced medications if they so choose and are prepared to pay that higher price. Under this system a single representative price (capitation rate) is calculated by a prescription payment plan manager for a group of related medications, usually including both branded and generic, and that price is paid to a pharmacy for all prescriptions of that group of medications fulfilled under the plan. The representative prices for different groups, including their minimum levels, are periodically reviewed and updated as appropriate.

Claims

1. A computer based method for improving pharmacy medication selection ratios in a prescription fulfillment plan which comprises:

a. defining within a healthcare processing computer a group of related medications dispensed by a pharmacy under said plan, determining within the healthcare processing computer the sales price and group sales percentage of each medication within said group, determining within the healthcare processing computer therefrom a group-weighted sales price for each said medication, and performing within the healthcare processing computer a calculation of a representative price by summing said group-weighted sales prices for all medications within said group;

b. excluding within the healthcare processing computer from said group and representative price calculation those related medications which have price structures that are not intermediate between higher priced brand name medications and lower priced generic medications within said group;

c. establishing within the healthcare processing computer a minimum amount at or above said representative price;

d. for each prescription fulfillment of a medication within said group, paying to said pharmacy an amount equal to the greater of the minimum or said representative price;

e. the healthcare processing computer periodically repeating step a; and

f. the healthcare processing computer periodically adjusting said minimum amount of step c.;

whereby each said pharmacy receives an incentive to preferentially fulfill said prescriptions with lower costs medications with said group when consistent with medical efficacy and prescriber instruction.

2. A method as in claim 1 wherein said representative price comprises an average rate on reimbursement of a pharmacy under said plan.

3. A method as in claim 1 wherein said group comprises at least one each of a branded medication and a generic medication.

4. A method as in claim 1, further comprising excluding within the healthcare processing computer from said group and representative price calculations medications which have been introduced to the market and medications for which the ingredient cost is greater than a normal range of ingredient costs for medications within the group.

5. A method as in claim 1 wherein periodic repetition of step d. occurs on a period determined by a period of overall sales activity of the medications of said group in the marketplace.

6. A method as in claim 5 wherein the period of overall sales activity is two weeks.

7. A method as in claim 1 wherein said periodic assessment of step f. occurs on a period length of not more than one year.

8. A method as in claim 1 further comprising defining within the healthcare processing computer a plurality of groups, each of which is comprised of medications of a single therapeutic class, and conducting steps b. through f. independently for each group, whereby said pharmacy receives different payment of different representative prices for different groups within said plurality, each said representative price being calculated such that said pharmacy has an incentive for each said group to fulfill prescriptions for medications within said group with a lower cost one of said medications.

9. A method as in claim 1 wherein data for steps a. and b. is stored in a healthcare processing computer database comprising medication identifications and current and historical prices and sales amounts for each medication within said database.

10. A method as in claim 4 wherein said exclusion for a newly introduced medication expires one year following the date of its introduction to the market, and thereafter said medication is included within said group.

11. A method as in claim 4 further comprising the healthcare processing computer subsequently reassessing said exclusion of a medication which has a price structure dissimilar to those medications within said group, at such time as there is a change in such price structure, and thereupon terminating said exclusion if such change has occurred and has been sufficient to make the then-current price structure of said medication comparable to price structures of medications already within said group.

12. A method as in claim 1 further comprising the healthcare processing computer step whereby pharmacy performance can be assessed over time according to drug category, prescription dispensing date and/or store with respect to prescription profit sums and averages overall and separately for branded and generic drugs.