Method for conducting prescription drug co-payment plans
AssigneeOmnicare, Inc.
InventorRalph F. Kalies
Life of this patent
Estimating the term…
Abstract
A credit card-based prescription benefits plan utilizes an electronic means for telecommunication to rapidly adjudicate prescription claims. The adjudication process includes a third-party claims processor interposed the pharmacy and the patient's credit card clearinghouse to ensure that the subscriber receives all benefits available under the plan. The third-party claims processor may also provide patient counseling and advocacy by performing patient-specifie drug regimen reviews to check for potential adverse drug reactions and drug interactions.
Claims14
A method of providing prescription benefits to subscribers under a plan, comprising the steps of:
- a) identifying a sponsor for a prescription benefits plan;
- b) designing the prescription benefits plan, to include a formulary of preferred medications;
- c) identifying at least one pharmacy that:
- i) participates in the prescription benefits plan,
- ii) receives prescriptions for medication and prescription benefit claims from subscribers, and
- iii) fulfills the prescriptions for a predetermined price;
- d) identifying at least one eligible subscriber having a valid credit or debit account with a creditor or institution and wishing to participate in the prescription benefits plan;
- e) enrolling each eligible subscriber who wishes to participate in the prescription benefits plan;
- f) generating an eligibility profile for each subscriber;
- g) establishing a prescription benefits manager to administer the prescription benefits plan;
- h) establishing a prescription claims processor that:
- i) receives claims for prescription benefits from a participating pharmacy;
- ii) adjudicates the claims in accordance with the subscriber's eligibility profile;
- and
- iii) upon approval of a claim, charges the subscriber's credit account for accepted claims, the amount of the charge being equal to the price of the prescription minus a predetermined co-payment which is tendered by the subscriber to the pharmacy at the time of fulfilling the prescription;
- i) a first payment, made by the creditor to the prescription benefits manager, the first payment being equal to the amount charged to the subscriber's account minus a first predetermined service fee to be retained by the creditor;
- j) a second payment, made by the prescription benefits manager to the pharmacy, the second payment being equal to a predetermined portion of the prescription price;
- and
- k) a third payment, made by the prescription benefits manager to the claims processor, the third payment being equal to a predetermined service fee.
Dependencies are inferred from the claim text.