Medicare pharmacy calculator II

• US 7,860,732 B2
• Filed: 10/09/2007
• Issued: 12/28/2010
• Est. Priority Date: 05/12/2005
• Status: Active Grant

• Current Assignee: Humana Incorporated
• Original Assignee: Humana Incorporated
• Inventors: Marco, Stephen L. Jr., Iyengar, Srinath S., Muse, Mark M., Townsend, David L., Augspurger, Kristen R., Loehr, Jason P., Elizabeth, Megan K., Stephens, Sarah A.
• Primary Examiner(s): GILLIGAN, CHRISTOPHER L
• Application Number:
  US11/869,339
• Publication Number:
  US 20080021736A1
• Time in Patent Office: 1,176 Days
• Field of Search: 705 2- 4
• US Class Current: 705/3
• 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 computerized method for calculating and displaying anticipated out-of-pocket pharmacy costs to a computer user under at least one Medicare Part D pharmacy benefit plan, comprising:

a) receiving at a server from said computer 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) determining at said server for each of said plurality of drugs an indicator of whether said drug is a maintenance drug or non-maintenance drug;

c) defining at said server a schedule for purchasing said drugs by 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;

i. said number of doses for said drug;

ii. said number of days supply for said drug;

iii. said number of fills for said drug; and

iv. said indicator of whether said drug is a maintenance drug or a non-maintenance drug;

d) calculating at said server 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. storing data for said 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;

v. repeating steps i-v for each drug fill; and

e) presenting to said computer user anticipated out-of-pocket costs for said plan period according to said schedule by;

i. presenting for each applicable month of said plan period an anticipated out-of-pocket cost for each drug fill assigned to said month wherein said 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; and

ii. presenting in association with each applicable month an indicator of whether more than one Medicare Part D stage is applicable to said month.

2. The computerized method of claim 1 further comprising prompting said computer user to change said schedule defining an order in which to purchase said plurality of drugs.

3. The computerized method of claim 2 further comprising:

f) receiving from said computer user said prescription data for said plurality of drugs according to a new schedule defining a different order for purchasing said drugs;

g) assigning at said server 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, said indicator of whether said drug is a maintenance drug or a non-maintenance drug, and said new schedule;

h) calculating and storing at said server a new anticipated out-of-pocket cost for said computer 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 schedule; and

i) presenting said total anticipated out-of-pocket cost according to said new schedule by presenting to said computer user for each applicable month of said plan period an anticipated out-of-pocket cost for each drug fill 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 computerized method of claim 1 wherein:

f) presenting in association with each applicable month an indicator of whether more than one Medicare Part D stage is applicable to said month comprises indicating when a new Medicare Part D stage begins.

5. The computerized method of claim 4 wherein:

g) presenting in association with each month an indicator of whether more than one Medicare Part D stage is applicable to said month comprises presenting to said computer user a number for said Medicare Part D stage applicable to said month.

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

7. The computerized method of claim 1 further comprising:

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

g) 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 computerized method of claim 1 further comprising:

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

g) presenting to said computer 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 computerized method for calculating and displaying anticipated out-of-pocket pharmacy costs to a computer user under at least one Medicare Part D pharmacy benefit plan, comprising:

a) receiving at a server from said computer 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) determining at said server for each of said plurality of drugs an indicator of whether said drug is a maintenance drug or non-maintenance drug;

c) defining at said server a schedule for purchasing said plurality of drugs by 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;

i. said number of doses for said drug;

ii. said number of days supply for said drug;

iii. said number of fills for said drug; and

iv. said indicator of whether said drug is a maintenance drug or a non-maintenance drug;

d) calculating and storing at said server 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;

e) calculating and storing at said server for each month of said plan period a total anticipated out-of-pocket cost 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;

f) presenting to said computer user a list of month-by-month out-of-pocket costs wherein said list comprises 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

g) presenting to said computer user in response to a request for details for a specified month;

i. a list of drug fills for said specified month, an anticipated out-of-pocket cost for each drug fill in said specified month;

ii. an indicator of whether more than one Medicare Part D stage is applicable to said drug fills for said specified month; and

iii. a running total of out-of-pocket costs based on said out-of-pocket costs for each drug fill in said list.

10. The computerized method of claim 9 wherein presenting to said computer user an indicator of whether more than one Medicare Part D stage is applicable to said drug fills for said specified month comprises inserting a stage identifier in said list of drug fills.

11. The computerized method of claim 9 further comprising:

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h) identifying at said server alternative drugs, if applicable, for each of said plurality of drugs received in said prescription data from said computer user;

i) assigning at said server 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;

j) calculating and storing at said server 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;

k) calculating and storing at said server 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

l) presenting to said computer 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 an indicator for a Medicare Part D stage applicable to said month for all applicable months of said plan period and a benefit to said computer user related to purchasing said alternative drug fill.

12. The computerized method of claim 9 further comprising:

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

i) assigning at server 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, said number of fills for said drug, and said indicator of whether said drug is a maintenance drug or a non-maintenance drug;

j) calculating and storing at said server 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;

k) calculating and storing at said server 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

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

13. The computerized method of claim 9 further comprising:

h) presenting to said computer 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 computerized method of claim 9 wherein said plan period is up to one year.

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

a) receiving at a server from said computer 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) determining at said server for each of said plurality of drugs an indicator of whether said drug is a maintenance drug or a non-maintenance drug;

c) defining at said server a schedule for purchasing said plurality of drugs by 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;

i. said number of doses for said drug;

ii said number of days supply for said drug;

iii said number of fills for said drug; and

iv. said indicator of whether said drug is a maintenance drug or a non-maintenance drug;

d) calculating at said server 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;

(vi) storing data for said 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;

(v) repeating steps i-v for each drug fill of said plurality of drugs; and

e) presenting to said computer user according to said schedule month-by-month anticipated out-of-pocket costs organized in a table comprising;

i. a listing of months for said plan period;

ii. a list of drug fills for each month;

iii. an anticipated out-of-pocket cost for each drug fill; and

iv. an indicator of whether more than one Medicare Part D stage is applicable to said drug fills for said month.

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

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

19. The computerized 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 computerized method of claim 15 further comprising:

f) prompting said computer user for a new schedule for purchasing said plurality of drugs; and

g) assigning at said server a drug fill to a month according to a new schedule defining a different order for purchasing said plurality of drugs received from said computer user.