Pharmaceutical clearinghouse method and system

• US 8,086,469 B2
• Filed: 03/28/2007
• Issued: 12/27/2011
• Est. Priority Date: 03/31/2006
• Status: Expired due to Fees

• Current Assignee: Sandeep Dayal
• Original Assignee: Sandeep Dayal
• Inventors: Dayal, Sandeep
• Primary Examiner(s): O'Connor, Gerald J.
• Assistant Examiner(s): NGUYEN, HIEP VAN
• Application Number:
  US11/692,639
• Publication Number:
  US 20070233517A1
• Time in Patent Office: 1,735 Days
• Field of Search: 705/2
• US Class Current: 705/2
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

A pharmaceutical clearinghouse establishes relationships with a set of foundations and a set of pharmaceutical providers; in response to the clearinghouse receiving a patient request for a pharmaceutical from a foundation, the clearinghouse obtains a subsidy from at least one provider and directs the subsidy to the foundation. The subsidy can be cash, in-kind drug, or a combination thereof.

Claims

1. A method of independently providing subsidies, in the form of cash, drugs as an in-kind subsidy or a combination of cash and drugs, from pharmaceutical providers to patients via foundations, the method comprising:

providing a computer-based clearinghouse system having a processor coupled to a data storage device and a network connection to enable communication with external computer systems over at least one network;

defining in the data storage device a network of foundations and a network of pharmaceutical providers;

receiving a request for a drug within a given and defined disease state from a foundation by the clearinghouse system, on behalf of a patient who has been prescribed that drug by a physician, from the network of foundations;

in response to the request, determining and requesting a subsidy to be provided by one or more pharmaceutical providers that have agreed to participate in providing subsidies for any drug prescribed within the pre-defined disease state from the network of pharmaceutical providers by the clearinghouse system;

directing the subsidy to the foundation as a response to the request by the clearinghouse system; and

the clearinghouse system maintaining an accounting of portions of the subsidy provided by each of the one or more of the participating pharmaceutical providers,

wherein the subsidy can include the requested drug, cash, or some combination thereof,

wherein the pharmaceutical provider has no influence or control over setting of the program rules by which the subsidy is disbursed in a given disease state,

wherein, the rules for the determination of the eligibility of a patient for subsidy and the amount and form of subsidy are based on a uniform criteria, which are based on defined measures of patient financial need including annual income below a multiple of the federally defined poverty level, set by the clearinghouse across all foundations participating in the clearinghouse network,

wherein the pharmaceutical providers contributions are not conditional on only their own brand of drug being prescribed to the patient or only their choice of a provider or specific pharmacy being used,

wherein the requested drug may or may not be manufactured by the pharmaceutical providers participating in the network,

wherein the burden of supporting brand of drugs manufactured by non-participating pharmaceutical providers is shared by the participating pharmaceutical providers in a manner proportional to the benefit derived by the pharmaceutical provider in the form of its own drug subsidies through the clearinghouse relative to the other pharmaceutical participants,

wherein there is no data exchange between the clearinghouse and the pharmaceutical provider or between the foundations and pharmaceutical providers that allows pharmaceutical subsidy providers to correlate their donations to the number of prescriptions subsidized by a charity, and

wherein the giving and receiving of the subsidy is double-blind, so that the one or more pharmaceutical providers do not know which foundation requested and patient received the subsidy, and the foundation and patient do not know which one or more pharmaceutical providers provided the subsidy.

2. The method of claim 1, further comprising:

determining if the drug is available from a pharmaceutical provider in the network of pharmaceutical providers.

3. The method of claim 2, wherein if the drug is available from the pharmaceutical provider, the method including:

the clearinghouse system requesting the pharmaceutical provider to provide the subsidy in the form of only the drug.

4. The method of claim 2, wherein if the drug is available from the pharmaceutical provider, the method including:

the clearinghouse system requesting the pharmaceutical provider to provide the subsidy in the form of the drug and cash.

5. The method of claim 2, wherein if the drug is available from the pharmaceutical provider the method including:

establishing a fair market value of the drug by the pharmaceutical provider providing at least a portion of the subsidy in the form of cash and procuring the drug on the open market with the cash.

6. The method of claim 1, wherein if the drug is not available from any pharmaceutical provider in the network of pharmaceutical providers, the method including:

determining an amount needed to procure the drug; and

determining a cash portion of the amount to be paid by one or more of the pharmaceutical providers in the network of pharmaceutical providers.

7. The method of claim 6, wherein determining the cash portion includes the clearinghouse system determining a pro rata portion to be paid by each of the one or more pharmaceutical providers, including determining the pro rata portion as a function of the total amount of all subsidies provided by the network of pharmaceutical providers.

8. The method of claim 1, including:

if the clearinghouse system receives multiple requests for the same drug for the same patient from a plurality of foundations, the clearinghouse system selecting only one of the multiple requests for receipt of the subsidy.

9. The method of claim 1, further comprising:

the clearinghouse system establishing a low-cost pharmaceutical provider threshold, whereby pharmaceutical providers that provide drugs that cost less than the low-cost threshold do not subsidize pharmaceutical providers having drugs that cost more than the low-cost threshold.

10. The method of claim 1, further comprising:

the clearinghouse system establishing a low-cost pharmaceutical provider threshold, whereby pharmaceutical providers that provide drugs that cost less than the low-cost threshold provide subsidies in a smaller proportion than pharmaceutical providers having drugs that cost more than the low-cost threshold.

11. The method of claim 1, further comprising:

the clearinghouse system applying a uniform and auditable standard of patient need assessment to determine eligibility for and the amount of the subsidy.

12. The method of claim 1, further including:

providing the subsidy in the form of one or more coupon that can be applied against the drug costs and patient co-pay for any drug in a given disease state.

13. A pharmaceutical clearinghouse system, configured to independently provide subsidies in the form of cash, drugs as an in-kind subsidy or a combination of cash and drugs, from pharmaceutical providers to foundations, the system comprising:

a network connection to enable communication with external computer systems over at least one network;

a computer storage device having stored therein information identifying a network of foundations and a network of pharmaceutical providers; and

at least one clearinghouse processor configured to;

receive a request for a drug within a given and defined disease state from a foundation, on behalf of a patient who has been prescribed that drug by a physician, from the network of foundations;

in response to the request, determine and request a subsidy to be provided by one or more pharmaceutical providers that have agreed to participate in providing subsidies for any drug prescribed within the pre-defined disease state from the network of pharmaceutical providers, while maintaining anonymity of the foundation;

direct the subsidy to the foundation as a response to the request; and

maintain an accounting of portions of the subsidy provided by each of the one or more of the participating pharmaceutical providers,

wherein the subsidy can include the requested drug, cash, or some combination thereof,

wherein the pharmaceutical provider has no influence or control over setting of the program rules by which the subsidy is disbursed in a given disease state,

wherein, the rules for the determination of the eligibility of a patient for subsidy and the amount and form of subsidy are based on a uniform criteria, which are based on defined measures of patient financial need including annual income below a multiple of the federally defined poverty level, set by the clearinghouse across all foundations participating in the clearinghouse network,

wherein the pharmaceutical providers contributions are not conditional on only their own brand of drug being prescribed to the patient or only their choice of a provider or specific pharmacy being used,

wherein the requested drug may or may not be manufactured by the pharmaceutical providers participating in the network,

wherein the burden of supporting brand of drugs manufactured by non-participating pharmaceutical providers is shared by the participating pharmaceutical providers in a manner proportional to the benefit derived by the pharmaceutical provider in the form of its own drug subsidies through the clearinghouse relative to the other pharmaceutical participants,

wherein there is no data exchange between the clearinghouse and the pharmaceutical provider or between the foundations and pharmaceutical providers that allows pharmaceutical subsidy providers to correlate their donations to the number of prescriptions subsidized by a charity, and

wherein the clearinghouse system is configured such that giving and receiving the subsidy is double-blind, so that the one or more pharmaceutical providers do not know which foundation requested and patient received the subsidy, and the foundation and patient do not know which one or more pharmaceutical providers provided the subsidy.

14. The system of claim 13, the at least one clearinghouse processor comprising:

an intake processor configured to determine if the foundation is in the network of foundations.

15. The system of claim 13, wherein the at least one clearinghouse processor is configured to determine if the drug is available from a pharmaceutical provider from the network of pharmaceutical providers and, if so, to request the subsidy from the pharmaceutical provider in the form of only the drug.

16. The system of claim 13, wherein the at least one clearinghouse processor is configured to determine if the drug is available from a pharmaceutical provider from the network of pharmaceutical providers and, if so, to request the subsidy from the pharmaceutical provider in the form of only the drug and cash.

17. The system of claim 13, wherein the at least one clearinghouse processor is configured to determine if the drug is available from a pharmaceutical provider from the network of pharmaceutical providers and, if so, to establish a fair market value of the drug by requesting the pharmaceutical provider to provide at least a portion of the subsidy in the form of cash to enable procurement of the drug on the open market with the cash.

18. The system of claim 13, wherein the at least one clearinghouse processor is configured to determine if the drug is available from a pharmaceutical provider from the network of pharmaceutical providers and, if not, to:

determine an amount needed to procure the drug; and

determine a cash portion of the amount to be paid by one or more of the pharmaceutical providers in the network of pharmaceutical providers.

19. The system of claim 18, wherein the at least one clearinghouse processor is configured to determine a pro rata portion of the cash portion to be paid by each of the one or more pharmaceutical providers, as a function of the total amount of all subsidies provided by the network of pharmaceutical providers.

20. The system of claim 13, wherein if the clearinghouse system receives multiple requests for the same drug for the same patient, the clearinghouse system is configured to select only one of the multiple requests for receipt of the subsidy.

21. The system of claim 13, wherein the clearinghouse system is configured to establish a low-cost pharmaceutical provider threshold, and the set of subsidy modules is configured to determine the subsidies such that pharmaceutical providers that provide drugs that cost less than the low-cost threshold do not subsidize pharmaceutical providers having drugs that cost more than the low-cost threshold.

22. The system of claim 13, wherein the clearinghouse system is configured to establish a low-cost pharmaceutical provider threshold, and the set of subsidy modules is configured to determine the subsidies such that pharmaceutical providers that provide drugs that cost less than the low-cost threshold provide subsidies in a smaller proportion than pharmaceutical providers having drugs that cost more than the low-cost threshold.

23. The system of claim 13, wherein the clearinghouse system is configured to apply a uniform and auditable standard of patient need assessment to determine eligibility for and the amount of subsidy.

24. The system of claim 13, wherein the clearinghouse is configured to provide the subsidy in the form of one or more coupons that can be applied against the drug costs and patient co-pay for any drug in a given disease state.