Pharmacy benefits management method and apparatus

A pharmacy benefits management system comprising:

• a processor server having claim information relating to pharmacy benefits claims processed by a claims processing facility stored therein, said claim information including identification of drugs dispensed to patients, said processor server also having pharmacy benefits formularly information stored therein;
• a management server having a processing module operative to extract patient pharmacy benefits information from the claim information and display a list of pharmacy benefits provided to a particular patient, said processing module further being operative to prompt a patient to input a response to verify accuracy of the list of pharmacy benefits and to retain and process the response;
• and
• a communication channel connected between said processor server and said management server and being operative to communicate information between said processor server and said management server.

A pharmacy benefits management system comprising

• a processor server having claim information relating to pharmacy benefits claims processed by a claims processing facility stored therein, said claim information including identification of drugs dispensed to patients, said processor server also having pharmacy benefits formularly information stored therein;
• a provider server having pharmacy benefits plan structure information stored therein;
• a management server having price information relating to drugs in various classes stored therein, said management server also having a processing module operative to search the claim information based on a selected filter and display a list of patients whose pharmacy benefits correspond to the selected filter;
• and
• a communication channel connected between said processor server, said provider server, and said management server and being operative to communicate information between said processor server, said provider server, and said management server.

A pharmacy benefits management server comprising

• means for downloading information from a processor server having claim information relating to pharmacy benefits claims processed by a claims processing facility, said claim information including identification of drugs dispensed to patients;
• means for downloading pharmacy benefits formularly information;
• means for downloading pharmacy benefits plan structure information stored therein;
• means for downloading price information relating to drugs in various classes stored therein;
• and
• means for correlating the claim information with the benefits plan structure information, the price information, and the formularly information to identify drugs expenses associated with selected drugs in accordance with the pharmacy benefits plan structure information, alternative drugs in the same class as the selected drugs, and expenses associated with the alternative drugs.

A pharmacy benefits management server comprising:

• means for downloading claim information relating to pharmacy benefits claims processed by a claims processing facility, said claim information including identification of drugs dispensed to patients;
• means for downloading pharmacy benefits formularly information;
• means for extracting patient pharmacy benefits information from the claim information and displaying a list of pharmacy benefits provided to a particular patient;
• means for prompting a patient to input a response to verify accuracy of the list of pharmacy benefits and retaining and processing the response.

A pharmacy benefits management server comprising

• means for downloading claim information relating to pharmacy benefits claims processed by a claims processing facility, said claim information including identification of drugs dispensed to patients;
• means for downloading pharmacy benefits formularly information;
• means for downloading pharmacy benefits plan structure information;
• means for downloading price information relating to drugs in various classes;
• and
• means for searching the claim information based on predetermined selected filter and displaying a list of patients whose pharmacy benefits correspond to the selected filters.

A pharmacy benefits management method comprising the steps of:

• downloading claim information relating to pharmacy benefits claims processed by a claims processing facility, said claim information including identification of drugs dispensed to patients;
• downloading having pharmacy benefits formularly information;
• downloading pharmacy benefits plan structure information;
• downloading price information relating to drugs in various classes;
• and
• correlating the claim information with the benefits plan structure information, the price information, and the formularly information to thereby identify drugs expenses associated with selected drugs in accordance with the pharmacy benefits plan structure information, alternative drugs in the same class as the selected drugs, and expenses associated with the alternative drugs.

A pharmacy benefits management method comprising the steps of:

• downloading claim information relating to pharmacy benefits claims processed by a claims processing facility, said claim information including identification of drugs dispensed to patients;
• downloading pharmacy benefits formularly information;
• extracting patient pharmacy benefits information from the claim information and displaying a list of pharmacy benefits provided to a particular patient;
• prompting a patient to input a response to verify accuracy of the list of pharmacy benefits;
• and
• retaining and processing the response in said prompting step.

A pharmacy benefits management method comprising the steps of:

• downloading claim information relating to pharmacy benefits claims processed by a claims processing facility, the claim information including identification of drugs dispensed to patients;
• downloading pharmacy benefits formularly information;
• downloading pharmacy benefits plan structure information;
• downloading price information relating to drugs in various classes;
• searching the claim information based on a predetermined selected filter;
• and
• displaying a list of patients whose pharmacy benefits correspond to the selected filters.