Computer implemented method and system for analyzing pharmaceutical benefit plans and for providing member specific advice, optionally including lower cost pharmaceutical alternatives

A computer implemented system provided by a pharmaceutical benefits manager, for reducing medication purchasing costs for a member of a pharmaceutical benefits plan managed by the pharmaceutical benefits manager, comprising:

• a medication analysis engine, provided by a pharmaceutical benefits manager, executing on a computer, analyzing a medication prescribed to the member;
• a plurality of databases connected to the medication analysis engine, including at least a medication information database, and a client profile database comprising pharmaceutical benefits plan information for members;
• recommending at least one substitute medication for the analyzed medication, wherein the recommendation is based on the client profile database and a member's pharmaceutical benefits plan, and wherein the recommendation is based on known medication substitutions, and wherein the member's pharmaceutical benefits plan is managed by the pharmaceutical benefits manager;
• where the medication analysis engine receives from a client interface, operated by the member, an authorization and selection an of a substitute medication from the at least one recommended medication;
• the medication analysis engine requesting approval from at least one of an authorizing physician, a pharmacist, and an authorizing health care professional, for the selected substitute medication;
• an approval request with the requested approval, and a plurality of other medication substitution requests grouped together on the approval request wherein the plurality of other medication substitution requests are from a plurality of members of pharmaceutical benefit plans managed by the pharmaceutical benefits manager for a plurality of members associated with said at least one of the authorizing physician, the pharmacist and the authorizing health care professional, and wherein said grouping enables said same at least one of the authorizing physician, the pharmacist and the authorizing health care professional for the plurality of members, to respond to the requested approval and the other requests for at least one of the selected substitute medication and other medications;
• the medication analysis engine processing the response to the requested approval and the other requests for the at least one selected substitute of the medication and the other medications for the members;
• and
• an interface for informing the member that the substitute medication was approved.

A method, implemented by a pharmaceutical benefits management computer system used by a pharmaceutical benefits manager, for reducing medication purchasing costs for a member of a pharmaceutical benefits plan managed by the pharmaceutical benefits manager, comprising:

• (a) requesting a medication to be analyzed from a member;
• (b) analyzing using the pharmaceutical benefits management computer system, the medication requested by the member;
• (c) recommending at least one substitute medication for the analyzed medication, wherein the recommendation is based on the pharmaceutical benefits plan of the member, and wherein the member's pharmaceutical benefits plan of the member is managed by the pharmaceutical benefits management computer system, and on a database of known medication substitutes;
• (d) receiving, from the member, at least one of an authorization and selection of a substitute medication for the at least one recommended medication;
• (e) requesting approval from at least one of an authorizing physician, a pharmacist and an authorizing health care professional, for the selected substitute medication;
• (f) grouping the requested approval with a plurality of other requests received for approvals of substitute medication for a plurality of members associated with same said at least one of the authorizing physician, the pharmacist and the authorizing health care professional, wherein the other requests for approval are received from a plurality of members of pharmaceutical benefit plans managed by the pharmaceutical benefits management system, and wherein said grouping enables said same at least one of the authorizing physician, the pharmacist and the authorizing health care professional for the plurality of members, to respond to the requested approval and the other requests for at least one of the selected substitute medication and other medications;
• (g) processing by the pharmaceutical benefits management computer system the response to the requested approval and the other requests for the at least one of the selected substitute medication and the other medications for the plurality of members;
• and
• (h) informing the plurality of members corresponding to the requested group approval, whether the substitute medication was approved.

A method, implemented by a pharmaceutical benefits management computer system used by a pharmaceutical benefits manager, for reducing medication purchasing costs for a member of a pharmaceutical benefits plan managed by the pharmaceutical benefits manager, using a wireless mobile computing device comprising:

• (a) requesting a medication to be analyzed from a member using a wireless mobile computing device;
• (b) analyzing using the pharmaceutical benefits management computer system, the medication requested by the member;
• (c) recommending at least one substitute medication for the analyzed medication, wherein the recommendation is based on the pharmaceutical benefits plan of the member, and wherein the member's pharmaceutical benefits plan of the member is managed by the pharmaceutical benefits management computer system;
• (d) receiving, from the member, at least one of an authorization and selection of a substitute medication for the at least one recommended medication;
• (e) requesting approval from at least one of an authorizing physician, a pharmacist and an authorizing health care professional, for the selected substitute medication;
• (f) grouping the requested approval with a plurality of other requests received for approvals of substitute medication for a plurality of members associated with same said at least one of the authorizing physician, the pharmacist and the authorizing health care professional, wherein the other requests for approval are received from a plurality of members of pharmaceutical benefit plans managed by the pharmaceutical benefits management system, and wherein said grouping enables said same at least one of the authorizing physician, the pharmacist and the authorizing health care professional for the plurality of members, to respond to the requested approval and the other requests for at least one of the selected substitute medication and other medications;
• (g) processing by the pharmaceutical benefits management computer system the response to the requested approval and the other requests for the at least one of the selected substitute medication and the other medications for the plurality of members;
• and
• (h) informing the plurality of members corresponding to the requested group approval, through the interface of the wireless mobile computing device, whether the substitute medication was approved.

A computer implemented system for reducing medication purchasing costs for a member of a pharmaceutical benefits plan comprising:

• a medication analysis engine executing on a computer, analyzing a medication prescribed to the member, the member selecting the medication from a database of medication claim history of the member, wherein the database is used to populate an interface allowing the member to select the medication to be analyzed;
• a plurality of databases connected to the medication analysis engine, including at least a client profile database comprising pharmaceutical benefits plan information for members;
• recommending at least one substitute medication for the analyzed medication, wherein the recommendation is based on the client profile database and a member's pharmaceutical benefits plan, and wherein the recommendation is based on known medication substitutions, and wherein at least one of the recommendations is stored in a database linked to the analyzed medication;
• wherein the medication analysis engine receives from a client interface, operated by the member, an authorization and selection of a substitute medication for the at least one recommended medication;
• the medication analysis engine requesting approval from at least one of an authorizing physician, a pharmacist, and an authorizing health care professional, for the selected substitute medication;
• an approval request with the requested approval, and a plurality of other medication substitution requests grouped together on the approval request, for a plurality of members associated with same said at least one of the authorizing physician, the pharmacist and the authorizing health care professional, and wherein said grouping enables said same at least one of the authorizing physician, the pharmacist and the authorizing health care professional for the plurality of members, to respond to the requested approval and the other requests for at least one of the selected substitute medication and other medications;
• the medication analysis engine processing the response to the requested approval and the other requests, the response being stored along with a plurality of other responses in a database of responses for the at least one selected substitute of the medication and the other medications for the members;
• and an interface for informing the member that the substitute medication was approved for at least one of their purchase and acquisition.