Method, apparatus, and computer program product for providing estimated prescription costs
AssigneeMcKesson Corporation
InventorsStacy Hopkins, Scott Genone, Mark Beers
Life of this patent
Estimating the term…
Abstract
A method, apparatus and computer program product are provided for providing a patient with prescribed medication cost information at a point of prescribing. A prescription benefit coverage inquiry is received and provided to a claims processor for processing. Historical data associated with prior prescription transactions is utilized to determine an estimated cost range of a prescribed medication in the event of an insufficient or absent response from a benefits manager. The estimated cost range is then provided to a prescriber to share with a patient. A targeted out-of-pocket cost according to incentives, such as vouchers and drug manufacturer rebates may also be provided.
Claims11
An apparatus comprising one or more processors and at least one memory including computer program code, that when executed by the at least one or more processors, causes the one or more processors to perform steps of:
- storing a time threshold and a history of prescription transactions;
- receiving, from a prescriber computer, a prescription benefit coverage inquiry associated with a patient and a prescribed medication;
- transmitting the prescription benefit coverage inquiry to a pharmacy claims processor computer;
- monitoring a network for receipt of a response associated with the prescription benefit coverage inquiry from the pharmacy claims processor computer;
- determining whether a response from the pharmacy claims processor computer is received within the time threshold;
- determining that an incentive is available based on the prescription benefit coverage inquiry;
- based on a determination that the response from the pharmacy claims processor computer is not received within the time threshold, and further based on the stored history of prescription transactions, generating an estimated cost range for the prescribed medication and transmitting the generated cost range and an incentive amount to the prescriber computer;
- and
- based on a determination that the response from the pharmacy claims processor is received within the time threshold, transmitting the incentive amount and the received response to the prescriber computer, wherein the response includes a pay amount field comprising a value.
A computer program product comprising at least one non-transitory computer-readable storage medium having computer-executable program code instructions stored therein, that when executed by one or more processors, cause the one or more processors to perform steps of:
- storing a time threshold and a history of prescription transactions;
- receiving, from a prescriber computer, a prescription benefit coverage inquiry associated with a patient and a prescribed medication;
- transmitting the prescription benefit coverage inquiry to a pharmacy claims processor computer;
- monitoring a network for receipt of a response associated with the prescription benefit coverage inquiry from the pharmacy claims processor computer;
- determining whether a response from the pharmacy claims processor computer is received within the time threshold;
- determining that an incentive is available based on the prescription benefit coverage inquiry;
- based on a determination that the response from the pharmacy claims processor computer is not received within the time threshold, and further based on the stored history of prescription transactions generating an estimated cost range for the prescribed medication and transmitting the generated cost range and an incentive amount to the prescriber computer;
- and
- based on a determination that the response from the pharmacy claims processor is received within the time threshold, transmitting the incentive amount and the received response to the prescriber computer, wherein the response includes a pay amount field comprising a value.
Dependencies are inferred from the claim text.