U.S. patent application number 11/608068 was filed with the patent office on 2007-07-12 for systems and methods for shifting prescription market share by presenting pricing differentials for therapeutic alternatives.
This patent application is currently assigned to NDCHEALTH CORPORATION. Invention is credited to Kenneth E. Burkett, Joseph Lee II Wiley.
Application Number | 20070162303 11/608068 |
Document ID | / |
Family ID | 38233812 |
Filed Date | 2007-07-12 |
United States Patent
Application |
20070162303 |
Kind Code |
A1 |
Wiley; Joseph Lee II ; et
al. |
July 12, 2007 |
Systems and Methods for Shifting Prescription Market Share by
Presenting Pricing Differentials for Therapeutic Alternatives
Abstract
While a pharmacist may know of other medications approved by the
FDA for the same medical condition, the pharmacist typically does
not know what the therapeutically equivalent dose of those products
is when compared to the originally prescribed item In addition to
this lack of equivalent dosage information, the pharmacist also is
unable to determine if any of those other FDA approved items will
save the consumer any money. Accordingly, embodiments of the
invention can provide pharmacists and/or consumers with equivalent
dosage information as well as pricing information for the
equivalent dosage. Accordingly, based at least in part on this
information, consumers may have an incentive to and may decide to
purchase to another prescription drug, thereby shifting market
share to a preferred prescription drug or pharmaceutical
manufacturer or provider.
Inventors: |
Wiley; Joseph Lee II;
(Douglasville, GA) ; Burkett; Kenneth E.;
(Southlake, TX) |
Correspondence
Address: |
SUTHERLAND ASBILL & BRENNAN LLP
999 PEACHTREE STREET, N.E.
ATLANTA
GA
30309
US
|
Assignee: |
NDCHEALTH CORPORATION
One National Data Plaza
Atlanta
GA
30329-2010
|
Family ID: |
38233812 |
Appl. No.: |
11/608068 |
Filed: |
December 7, 2006 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60748432 |
Dec 8, 2005 |
|
|
|
Current U.S.
Class: |
705/2 ; 705/400;
705/7.35 |
Current CPC
Class: |
G16H 20/10 20180101;
G06Q 30/0206 20130101; G06Q 10/10 20130101; G06Q 30/0283
20130101 |
Class at
Publication: |
705/002 ;
705/010; 705/400 |
International
Class: |
G06Q 10/00 20060101
G06Q010/00; G07G 1/00 20060101 G07G001/00; G06F 17/00 20060101
G06F017/00 |
Claims
1. A method for facilitating a shift in drug market share,
comprising: receiving prescription drug information associated with
a consumer; based at least in part on the prescription drug
information, determining at least one alternative drug and cost
savings information associated with purchasing the alternative drug
in lieu of a prescription drug associated with the prescription
drug information; providing, for review by an entity, the identity
of the alternative drug and cost savings information; and receiving
decision information associated with the consumer, wherein the
decision information includes a decision to switch from the
prescription drug to the alternative drug.
2. The method of claim 1, further comprising: providing at least a
portion of the decision information to at least one provider
associated with the alternative drug; and receiving new pricing
information associated with the alternative drug.
3. The method of claim 1, further comprising: providing, to a third
party, at least a portion of the decision information, wherein at
least one provider associated with the alternative drug receives
the portion of decision information; and receiving new pricing
information associated with the alternative drug.
4. The method of claim 1, further comprising: based at least in
part on a portion of the decision information, receiving a rebate
revenue from at least one provider.
5. The method of claim 3, wherein the third party comprises at
least one of the following: a pharmaceutical benefits manager.
6. The method of claim 1, wherein determining at least one
alternative drug and cost savings information associated with
purchasing the alternative drug in lieu of a prescription drug
associated with the prescription drug information comprises:
accessing a data storage device comprising a list of a plurality of
alternative drugs, dosage information associated with each of the
plurality of alternative drugs, and pricing information associated
with each of the plurality of alternative drugs; comparing a dosage
associated with the prescription drug with a portion of information
stored in the data storage device; and determining whether one or
more alternative drugs that have substantially similar therapeutic
effects as the prescription drug exist.
7. The method of claim 1, wherein determining at least one
alternative drug comprises receiving alternative drug information
from a third party.
8. The method of claim 1, wherein determining at least one
alternative drug and cost savings information associated with
purchasing the alternative drug in lieu of a prescription drug
associated with the prescription drug information comprises:
determining a price associated with the alternative drug;
determining a price associated with the prescription drug;
determining a difference between the price associated with the
alternative drug and the price associated with the prescription
drug.
9. The method of claim 1, wherein determining at least one
alternative drug and cost savings information associated with
purchasing the alternative drug in lieu of a prescription drug
associated with the prescription drug information comprises: based
at least in part on at least one predefined discount rule,
determining a true price associated with the alternative drug;
based at least in part on at least one predefined discount rule,
determining a true price associated with the prescription drug;
determining a difference between the true price associated with the
alternative drug and the true price associated with the
prescription drug.
10. The method of claim 9, wherein at least one predefined discount
rule is defined by a therapeutic alternative program, a therapeutic
alternative program module, a pharmaceutical benefits manager, a
pharmaceutical manufacturer or provider, a physician, or a
pharmacist.
11. The method of claim 1, wherein providing, for review by an
entity, the identity of the alternative drug and cost savings
information comprises: transmitting a message to an entity
regarding a cost savings associated with an alternative drug, and
requesting approval to switch from the prescription drug to the
alternative drug.
12. The method of claim 1, wherein the entity comprises at least
one of the following: a consumer, a patient, a guardian, a
pharmacy, a physician, a pharmaceutical benefits manager, a health
care provider, a health medical organization, an insurance company,
or a benefits plan manager.
13. A computer-implemented method for facilitating a shift in drug
market share, comprising: receiving, at a switch provider, a
message from a pharmacy, wherein the message includes information
identifying a requested drug; identifying one or more alternative
drugs for the requested drug, wherein the alternative drugs have
substantially similar therapeutic effects as the requested drug;
determining that at least one of the identified alternative drugs
are priced at lower price than the requested drug; and
transmitting, to the pharmacy, an indication of availability of at
least one alternative drug and pricing information associated with
the at least one alternative drug.
14. The method of claim 13, further comprising: receiving decision
information associated with a selection of at least one alternative
drug; providing at least a portion of the decision information to
at least one provider associated with the at least one alternative
drug; and receiving new pricing information associated with the at
least one alternative drug.
15. The method of claim 13, further comprising: providing decision
information associated with a plurality of alternative drugs to at
least one provider associated with at least one alternative drug;
and receiving new pricing information associated with the at least
one alternative drug.
16. The method of claim 13, further comprising: based at least in
part on a portion of the decision information, receiving a rebate
revenue from at least one provider.
17. The method of claim 13, wherein identifying one or more
alternative drugs for the requested drug comprises: accessing a
data storage device comprising a list of a plurality of alternative
drugs, dosage information associated with each of the plurality of
alternative drugs, and pricing information associated with each of
the plurality of alternative drugs; and comparing a dosage
associated with the requested drug with a portion of information
stored in the data storage device.
18. The method of claim 13, wherein identifying one or more
alternative drugs for the requested drug comprises receiving
alternative drug information from a third party.
19. The method of claim 13, wherein determining that at least one
of the identified alternative drugs are priced at lower price than
the requested drug comprises: determining a price associated with
an alternative drug; determining a price associated with the
requested drug; determining a difference between the price
associated with the alternative drug and the price associated with
the requested drug.
20. The method of claim 13, wherein determining that at least one
of the identified alternative drugs are priced at lower price than
the requested drug comprises: based at least in part on at least
one discount rule, determining a true price associated with the
alternative drug; based at least in part on at least one discount
rule, determining a true price associated with the requested drug;
determining a difference between the true price associated with the
alternative drug and the true price associated with the requested
drug.
21. The method of claim 13, wherein transmitting, to the pharmacy,
an indication of availability of at least one alternative drug and
pricing information associated with the at least one alternative
drug comprises transmitting a message to an entity regarding a cost
savings associated with an alternative drug, and requesting
approval of a switch to the alternative drug.
22. The method of claim 13, wherein the entity comprises at least
one of the following: a consumer, a patient, a guardian, a
pharmacy, a physician, a health care provider, a health medical
organization, an insurance company, or a benefits plan manager
23. A computer-implemented method for obtaining an alternative to a
prescription drug from a pharmacy, comprising: requesting a
prescription drug from a therapeutic alternative program;
receiving, from the therapeutic alternative program, information
identifying one or more alternative drugs, wherein each of the
alternative drugs has substantially similar therapeutic effects as
the prescription drug; receiving, from the therapeutic alternative
program, information associated with a price savings, wherein one
or more of the alternative drugs is priced lower than the requested
prescription drug; and transmitting a switch request to the
therapeutic alternative program, wherein the switch request
comprises a request for at least one alternative drug in lieu of
the initially requested prescription drug.
24. A system for facilitating a shift in drug market share,
comprising: a therapeutic alternative program module operable to:
receive prescription drug information associated with a consumer;
based at least in part on the prescription drug information,
determine at least one alternative drug and cost savings
information associated with purchasing the alternative drug in lieu
of a prescription drug associated with the prescription drug
information; provide, for review by an entity, the identity of the
alternative drug and cost savings information; and receive decision
information associated with the consumer, wherein the decision
information includes a decision to switch from the prescription
drug to the alternative drug.
25. A system for facilitating a shift in drug market share,
comprising: a therapeutic alternative program module operable to:
receive, at a switch provider, a message from a pharmacy, wherein
the message includes information identifying a requested drug;
identify one or more alternative drugs for the requested drug,
wherein the alternative drugs have substantially similar
therapeutic effects as the requested drug; determine that at least
one of the identified alternative drugs are priced at lower price
than the requested drug; and transmit, to the pharmacy, an
indication of availability of at least one alternative drug and
pricing information associated with the at least one alternative
drug.
26. A system for obtaining an alternative to a prescription drug
from a pharmacy, comprising: a computer program module operable to:
request a prescription drug from a therapeutic alternative program;
receive, from the therapeutic alterative program, information
identifying one or more alternative drugs, wherein each of the
alternative drugs has substantially similar therapeutic effects as
the prescription drug; receive, from the therapeutic alternative
program, information associated with a price savings, wherein one
or more of the alternative drugs is priced lower than the requested
prescription drug; and transmit a switch request to the therapeutic
alternative program, wherein the switch request comprises a request
for at least one alternative drug in lieu of the initially
requested prescription drug.
27. A method for facilitating a shift in drug market share,
comprising: offering one or more drugs to a pharmacy at an initial
price, wherein the drugs can be used to fill prescriptions
associated with consumers; establishing a rebate program with the
pharmacy to provide a price reduction for a prescribed drug based
on a predefined shift in market share for the prescribed drug;
receiving, from a therapeutic alternative program, information
associated with a shift in market share for one of the drugs; based
at least in part on the shift in market share, determining whether
the drug is eligible for a price reduction; and if the drug is
eligible for a price a reduction, offering the drug to the pharmacy
at a reduced price, wherein the drug can be used to fill a
prescription requested by a consumer
28. A method for enhancing revenues of a pharmacy, comprising:
establishing a customer program at a pharmacy for cash customers;
providing one or more program rules for the customer program,
wherein at least one program rule specifies at least an amount of a
discount for one or more drugs; receiving at least one drug order
from a cash customer at the pharmacy; providing the drug order to a
switch provider; identifying, via the switch provider, one or more
alternative drugs for the drug associated with the drug order,
wherein the alternative drugs have substantially similar
therapeutic effects as the drug associated with the drug order;
determining that one or more of the identified alternative drugs
are priced at a lower price than the drug associated with the drug
order, wherein the prices for the alternative drugs are based at
least in part on one or more of the program rules; and
transmitting, to the pharmacy, an indication of availability of one
or more alternative drugs and pricing information associated with
the one or more alternative drugs.
Description
RELATED APPLICATION
[0001] This application claims priority to U.S. provisional
application Ser. No. 60/748,432, entitled "Systems and Methods for
Shifting Prescription Market Share By Presenting Pricing
Differentials for Therapeutic Alternatives," filed on Dec. 8,
2005.
FIELD OF THE INVENTION
[0002] Aspects of the invention relate generally to prescriptions,
and more particularly, to systems and methods for driving market
share for medications or pharmaceutical manufacturers or providers
by presenting pricing differentials for therapeutic
alternatives.
BACKGROUND OF THE INVENTION
[0003] The cost for prescription drugs and other medicines can be a
recurring and increasing expense for many consumers. Pharmaceutical
companies and generic drug manufacturers or providers can offer
consumers competing drug and medicine products at different,
sometimes substantially different, prices. In many instances,
consumers may be unaware of the availability of and relative prices
between the variety of drug and medicine product choices, including
alternative drugs such as generic drugs.
[0004] In many instances, a consumer may be prescribed a brand name
drug by his or her physician, which may be relatively more
expensive than other competing, alternative drugs, such as a
generic drug with therapeutically equivalent effects. Sometimes, a
consumer can obtain information regarding alternative drug products
by asking his or her physician and/or pharmacist whether such
alternative or generic drugs exist. In other instances, a consumer
can determine similar information by conducting independent
research.
[0005] Obtaining alternative drug product information from a
physician and/or pharmacist or by conducting independent research
can be difficult and time consuming. A common drawback to asking a
physician whether alternative drug products exist is that the
physician may not know the relative costs of the alternative drug
products compared to a prescribed drug. A drawback to asking a
physician and/or pharmacist whether alternative drug products exist
is that the consumer must be sophisticated enough to ask his or her
physician and/or pharmacist whether alternative drug products
exist. A drawback to conducting independent research for such drug
products is that the research may be relatively technical, and
there is a possibility that a consumer could misidentify a drug
product, or misidentify a dosage of a particular alternative drug
that is not a relatively safe alternative to the initially
prescribed drug.
[0006] Therefore, a need exists for systems and methods for
identifying an alternative to prescription drug products.
[0007] In addition, a need exists for systems and methods for
obtaining an alternative to a prescription drug from a
pharmacy.
[0008] Furthermore, a need exists for systems and methods for
facilitating a shift in drug market share.
[0009] Moreover, a need exists for systems and methods for
enhancing revenues of a pharmacy.
[0010] An additional need exists for systems and methods for
driving market share for medications or pharmaceutical
manufacturers or providers by presenting pricing differentials for
therapeutic alternatives.
SUMMARY OF THE INVENTION
[0011] Embodiments of the invention can provide some or all of the
above needs. Embodiments of the invention can provide mechanisms
for driving market share towards certain medications or
pharmaceutical manufacturers or providers in the 100% co-pay (e.g.,
discount programs), cash, and funded (e.g., insurance plans)
transaction marketplace. In an embodiment of the invention, the
100% co-pay and cash transactions described with respect to systems
and methods disclosed herein, can be in accordance with
transactions disclosed in U.S. Provisional Application No.
60/711,743, filed Aug. 26, 2005, and entitled "SYSTEMS AND METHODS
FOR PROVIDING PHARMACY DISCOUNTS FOR CASH CUSTOMERS WHILE
MAINTAINING THIRD-PARTY REIMBURSEMENT RATES," the contents of which
are hereby incorporated by reference. In particular, as described
by embodiments in further detail below, the 100% co-pay and cash
transactions may be facilitated between a pharmacy and a switch
provider, which may implement mechanisms for driving market share
towards certain medications or pharmaceutical manufacturers
[0012] In accordance with embodiments of the invention, a consumer
may be provided with certain information in order to provide
incentives to the consumer to select another medication or
pharmaceutical manufacturer or provider. In particular, the
consumer ordering a particular medication may be presented with
information regarding other medications that may meet the
consumer's health requirements by providing the same therapeutic
results. If there are other medications that will meet the
consumer's health requirements, then the consumer may also be
presented with information specifying which, and the extent to
which, those other medications will decrease the consumer's
medication costs.
[0013] In accordance with another embodiment of the invention, a
Therapeutic Alternative Program may be implemented that provides
mechanisms for driving current 100% co-pay and cash consumer
purchase decisions toward a preferred manufacturer's or provider's
products, thereby creating a market shift for the preferred
manufacturer or provider. In this example embodiment, a consumer
may present a prescription for a medication to a pharmacy. The
pharmacy receiving such a request may transmit an electronic claim,
via modem, lease line or other electronic data transmission medium
over a network, to a switch provider such as NDCHealth's
Intelligent Network. The switch provider may interconnect one or
more pharmacies with one or more pharmacy benefit managers (PBMs)
using one or more networks, including private networks or the
Internet. The electronic claim from the pharmacy may identify the
medication, and in some embodiments, the pharmacy's current pricing
information.
[0014] Next, the switch provider may compare the submitted
medication with a set of pharmaceutical products known to have the
same or similar therapeutic effects. With respect to the set of
pharmaceutical products, the switch provider has already contracted
with pharmaceutical manufacturers or providers to obtain market
share related volume rebates. From the set of pharmaceutical
products known to have the same or similar therapeutic effects, the
switch provider will then determine equivalent dosages of the
alternative products. Having determined the equivalent dosages of
the alternative products, the switch provider can then determine
whether those particular alternative products will result in a cost
savings to the consumer compared to the originally requested
medication.
[0015] In accordance with an embodiment of the invention, the
switch provider may access or otherwise include a data storage
device, database, or other look-up table for determining equivalent
dosages of the alternative products as well as the potential cost
savings. In particular, the switch provider may maintain a database
or table of non-preferred pharmaceutical products as well as a
database or table of preferred pharmaceutical products that have
equivalent therapeutic effects as the non-preferred pharmaceutical
products. Using the database and/or tables, each of these
non-preferred pharmaceutical products may be cross-referenced with
preferred pharmaceutical products known to have equivalent
therapeutic effects. In addition, the database and/or tables will
also have specified equivalent dosages between the preferred and
non-preferred drugs. Further, pricing information for the preferred
pharmaceutical products will be included. In accordance with one
embodiment of the invention, this pricing information may be set by
the pharmacy. In another embodiment of the invention, the pricing
information may be set by the switch provider, perhaps based in
part upon previously-negotiated rebates with manufacturers or
providers. Other embodiments may have pricing information set by
the pharmacy benefits managers (PBMs).
[0016] Accordingly, if the switch provider is able to identify one
or more alternative medications that result in a cost savings to
the consumer, the switch provider may not complete the initial
request for the original medication. Instead, the switch provider
may transmit a message to the pharmacy, for example, stating
perhaps "Preferred Drug Entity A will save you $XX.XX. To override
this rejection, enter XXXX into the prior authorization field." As
described above, the preferred drug entity A may be one of the
items for which the switch provider has a contract in place with
the manufacturer or provider of drug entity A to provide volume
rebates in exchange for positive market share shift. A portion of
the rebate dollars that are generated by this contract may be
provided to the pharmacy in order to incentivize them to
participate in this Therapeutic Alternative Program and to provide
a greater cash pricing differential for the preferred medications
as compared to the non-preferred medications.
[0017] In accordance with another example embodiment of the
invention, the Therapeutic Alternative Program's functionality may
also be implemented in the funded transaction market by providing
similar messaging to the pharmacy informing them of
therapeutically-equivalent medications on the payer's preferred
drug list and a lower co-pay cost associated with the use of those
items as compared to the ones that are absent from that list. One
of ordinary skill in the art will readily recognize that many other
variations of the Therapeutic Alternative Program are possible.
[0018] Therefore various systems and processes according to
embodiments of the invention can include:
[0019] (1) Systems and methods for identifying an alternative to
prescription drug products;
[0020] (2) Systems and methods for obtaining an alternative to a
prescription drug from a pharmacy;
[0021] (3) Systems and methods for facilitating a shift in drug
market share;
[0022] (4) Systems and methods for enhancing revenues of a
pharmacy; and
[0023] (5) Systems and methods for driving market share for
medications or pharmaceutical manufacturers or providers by
presenting pricing differentials for therapeutic alternatives.
[0024] Other systems and processes according to various embodiments
of the invention will become apparent with respect to the remainder
of this document.
BRIEF DESCRIPTION OF THE DRAWINGS
[0025] Reference will now be made to the accompanying drawings,
which are not necessarily drawn to scale, and wherein:
[0026] FIG. 1 illustrates an example embodiment of the invention
where a 100% co-pay plan is hosted by a switch provider.
[0027] FIG. 2 illustrates an example embodiment of the invention
where a 100% co-pay plan is hosted by an entity other than a switch
provider.
[0028] FIG. 3 illustrates an example embodiment of the invention
involving funded plans.
[0029] FIG. 4 illustrates an example system in accordance with an
embodiment of the invention.
[0030] FIGS. 5-9 are process flowcharts illustrating example
methods in accordance with embodiments of the invention.
DETAILED DESCRIPTION
[0031] The invention now will be described more fully hereinafter
with reference to the accompanying drawings, in which embodiments
of the invention are shown. This invention may, however, be
embodied in many different forms and should not be construed as
limited to the embodiments set forth herein; rather, these
embodiments are provided so that this disclosure will be thorough
and complete, and will fully convey the scope of the invention to
those skilled in the art. Like numbers refer to like elements
throughout.
[0032] The invention is described below with reference to block
diagrams and flowchart illustrations of systems, methods,
apparatuses and computer program products according to embodiments
of the invention. It will be understood that each block of the
block diagrams and flowchart illustrations, and combinations of
blocks in the block diagrams and flowchart illustrations,
respectively, can be implemented by computer program instructions.
These computer program instructions may be loaded onto a general
purpose computer, special purpose computer such as a switch, or
other programmable data processing apparatus to produce a machine,
such that the instructions which execute on the computer or other
programmable data processing apparatus create means for
implementing the functions specified in the flowchart block or
blocks.
[0033] These computer program instructions may also be stored in a
computer-readable memory that can direct a computer or other
programmable data processing apparatus to function in a particular
manner, such that the instructions stored in the computer-readable
memory produce an article of manufacture including instruction
means that implement the function specified in the flowchart block
or blocks. The computer program instructions may also be loaded
onto a computer or other programmable data processing apparatus to
cause a series of operational elements or steps to be performed on
the computer or other programmable apparatus to produce a computer
implemented process such that the instructions that execute on the
computer or other programmable apparatus provide elements or steps
for implementing the functions specified in the flowchart block or
blocks.
[0034] Accordingly, blocks of the block diagrams and flowchart
illustrations support combinations of means for performing the
specified functions, combinations of elements or steps for
performing the specified functions and program instruction means
for performing the specified functions. It will also be understood
that each block of the block diagrams and flowchart illustrations,
and combinations of blocks in the block diagrams and flowchart
illustrations, can be implemented by special purpose hardware-based
computer systems that perform the specified functions, elements or
steps, or combinations of special purpose hardware and computer
instructions.
[0035] The terms "alternative drug", "therapeutic alternative",
"therapeutic equivalent", "therapeutic equivalent drug",
"therapeutically equivalent drug", and "therapeutically equivalent
item" are used interchangeably throughout the description, and
should be construed to cover any drug, medication, or chemical
composition having the same effects, similar effects, or
substantially similar therapeutic effects on a person, patient, or
consumer as a prescribed drug, medication, or chemical composition
when taken in an appropriate dosage.
[0036] Having generally described the operation of the Therapeutic
Alternative Program, three example embodiments of the Therapeutic
Alternative Program will now be described with reference to FIGS.
1-3.
EXAMPLE 1
100% co-pay plan hosted by switch provider
[0037] In a first embodiment of the invention, a switch provider
may host a Therapeutic Alternative Program (TAP) or therapeutic
alternative program module in addition to a 100% co-pay plan. In
this first embodiment of the invention, a transaction received at
the switch provider from the pharmacy may be exposed to a system of
editing functionality that will compare the submitted drug entity
and dosage to a known set of therapeutically-equivalent preferred
items. Based upon the submitted drug entity and dosage submitted,
the switch provider may populate a list of equivalent drug
entities, dosages, and the respective pricing, available
manufacturer or provider rebates, coupons, vouchers, patient
assistance, or similar price reduction methodologies associated
with each. If a therapeutically-equivalent entity exists on this
list, that item(s) will be utilized to populate the messaging
notifying the pharmacy of the preferred entity. The pricing will be
utilized to calculate the difference between the non-preferred item
(e.g., the originally submitted drug entity) and the preferred
entity and will also populate the messaging. The transaction may
then be returned to the pharmacy as a rejected claim. If the
pharmacy chooses to override the rejection, they will enter the
appropriate (provided) override code into the prior authorization
field and the claim will be allowed to transact without further
intervention. The next time that claim is submitted, the pharmacy
may receive the same message and may have to choose what action to
take. If the pharmacy educates the patient and the physician about
the opportunity and a change is made to the preferred item, the
pharmacy will submit a claim for a preferred item instead. On the
other hand, the editing system may not invoke a rejection when the
claim is submitted for a preferred item. One of ordinary skill in
the art will recognize that current cash transactions would
essentially become 100% co-pay transactions that are processed as
indicated above.
[0038] This first embodiment will now be described with reference
to FIG. 1. In FIG. 1, as shown in 101, a transaction leaves the
pharmacy and enters the switch provider's TAP before it reaches the
switch provider's 100% co-pay plan where pricing of the claim would
be set. In 101, the switch provider will determine the therapeutic
alternatives and calculate the cost savings by utilizing the
therapeutic alternative price compared to the submitted price. The
true price for the both items will be calculated by utilizing the
100% co-pay plan's rules for discounts. The true prices will be
compared and the messaging will be created and sent back to the
pharmacy in 102. In particular, in 102, the messaging of a
therapeutically equivalent drug, dosage and cost savings will be
communicated to the pharmacy. The pharmacy may print (or otherwise
communicate) the messaging to provide to the patient. If the
patient requests to try the alternative drug, the pharmacy will
call the physician for approval. The pharmacy will provide the
physician with the therapeutically-equivalent drug name, dosage,
and cost savings for the patient. If the physician chooses to make
the change, the pharmacy will re-submit the prescription claim for
the alternate drug. If the change is not approved by either the
patient or the physician, the pharmacy can override the rejection
and re-submit the original drug.
[0039] Next, in 103, the pharmacy will submit either the original
drug or the preferred alternative. If it is the original drug, the
Therapeutic Alternative Program or therapeutic alternative program
module may check to make sure the pharmacy entered the proper
override code. Once verified, the transaction may proceed to the
100% co-pay plan hosted at the switch provider for pricing based on
the rules within that program. If it is the alternative drug, the
transaction will proceed to the 100% co-pay plan hosted at the
switch provider for pricing based on the rules within that program.
In 104, the switch provider may return, to the pharmacy, the
correct pricing for the drug entity requested based on the rules
contained in the 100% co-pay plan hosted at the switch
provider.
[0040] Now referring to 105, the switch provider may capture all of
the data elements necessary from its pharmacy participants and
compile it into a format that will provide information concerning
market share shifts attained for the specific drug entities for
which pharmaceutical manufacturers or providers have contracted to
provide volume rebates for such shifts. The switch provider will
then provide this information to the pharmaceutical manufacturers
or providers to obtain the rebate revenues on behalf of its
pharmacy participants. As shown in 106, the pharmaceutical
manufacturer or provider may provide rebate revenues to the switch
provider as provided for in the contractual agreements between the
two parties. In 107, the switch provider will sort the rebate
revenues based on market share shift attained by the different
pharmacy participants and provide a portion of these revenues to
the pharmacy participants, withholding a previously agreed upon
amount for the act of providing this functionality, aggregation,
revenue attainment and disbursement.
EXAMPLE 2
100% co-pay plan hosted by an entity other than the switch
provider
[0041] In a second embodiment of the invention, the switch provider
may host a Therapeutic Alternative Program (TAP), but the 100%
co-pay plan may be hosted by an entity other than the switch
provider. Accordingly, in this second embodiment, the claim will
come to the switch provider while on its way to a 100% co-pay
claims processor, such a Pharmacy Benefits Manage (PBM). The
Therapeutic Alternative Program will function in substantially the
same way as described above, except the market share shift may be
driven by the preferred drug list that is in place at the switch
provider instead of any preferred drug list that may or may not be
in place at the 100% co-pay claims processor.
[0042] This second embodiment will now be described with reference
to FIG. 2. In FIG. 2, as shown in 201, a transaction leaves the
pharmacy and enters the switch provider's TAP before it reaches the
hosted 100% co-pay plan at the PBM where pricing of the claim would
be set. In 201, the therapeutic alternatives will be determined and
the cost savings will be calculated by utilizing the therapeutic
alternative price compared to the submitted price. The true price
for the both items will be calculated by utilizing the 100% co-pay
plan's rules for discounts. The true prices will be compared and
the messaging will be created and sent back to the pharmacy (202).
In 202, a messaging containing a therapeutically equivalent drug,
dosage and cost savings will be communicated to the pharmacy. The
pharmacy may print the messaging (or otherwise communicate) to
provide to the patient. If the patient requests to try the
alternative drug, the pharmacy will call the physician for
approval. The pharmacy will provide the physician with the
therapeutically-equivalent drug name, dosage, and cost savings for
the patient. If the physician chooses to make the change, the
pharmacy will re-submit the prescription claim for the alternate
drug. If the change is not approved by either the patient or the
physician, the pharmacy can override the rejection and re-submit
the original drug.
[0043] As shown in 203, the pharmacy may submit either the original
drug or the preferred alternative. If it is the original drug, the
Therapeutic Alternative Program will check to make sure the
pharmacy entered the proper override code. In 204, the switch
provider will forward the claim to the Prescription Benefits
Manager (PBM) that hosts the 100% co-pay the plan for appropriate
pricing. In 205, the PBM will return the claim to the switch
provider in order for it to be returned to the pharmacy. The switch
provider will return the claim to the pharmacy as shown in 206.
[0044] In 207, the PBM will aggregate all of the claims from its
pharmacy participants and submit the appropriate information to
manufacturers or providers for any rebate dollars that are
available for 100% co-pay claims that have not been exposed to
market-share influencing functionality (the Therapeutic Alternative
Program functionality). In 208, the PBM may receive some amount of
volume rebates from manufacturers or providers. In 209, the PBM may
provide some share of these rebates to the pharmacy participant(s).
As shown in 210, the pharmacy has its own separate contracts with
the manufacturers or providers to provide functionality that will
provide market share shift toward that specific manufacturer's or
provider's product(s) (the Therapeutic Alternative Program). The
pharmacy submits the appropriate data to the pharmaceutical
manufacturer or provider in order to obtain volume rebate revenue
for the market share shift that was attained.
EXAMPLE 3
Funded Plans
[0045] A third embodiment of the invention may involve the use of a
switch provider's Therapeutic Alternative Program (TAP) in the
funded transaction marketplace. In this third embodiment, the
preferred drug list would be provided by the funded program
(Prescription Benefits Manager or PBM) along with the means of
identifying the patient and the co-pay differentials associated
with the consumer choosing a preferred item. The claim would come
to the switch provider where it would be subjected to editing to
determine the presence of one or more alternative, preferred
item(s) and the co-pay differential associated with using one of
the preferred item(s). That information would be returned to the
pharmacy in the same fashion as previously described.
[0046] This third embodiment will now be described with reference
to FIG. 3. In FIG. 3, as shown in 301, a transaction leaves the
pharmacy and enters the switch provider's TAP before it reaches the
PBM for adjudication. In the TAP, the submitted drug entity will be
compared to the list of preferred drugs within the same therapeutic
category as provided by the PBM. If it is not on that list, the
co-pay differential will be obtained from information provided by
the PBM and the transaction will be rejected to the pharmacy. In
302, in the rejected transaction a message will be inserted that
will identify the preferred therapeutic alternatives and the co-pay
savings that with patient will realize if one of the preferred
alternatives are chosen. The pharmacy may choose either to override
the rejection and fill for the original drug or he may educate the
patient and the physician as necessary to cause a change to the
preferred drug entity.
[0047] Next, in 303, the pharmacy may submit either the original
drug or the interchanged, preferred drug entity. The transaction
will enter the TAP program and be examined for either an
appropriate override code or a preferred drug entity. Once this has
been verified, the claim is passed on to the PBM for adjudication
and pricing (304). In 305, the claim is returned to the switch
provider in order to be returned to the pharmacy. The claim is
returned to the pharmacy as shown in 306.
[0048] As shown in 307, the PBM aggregates all of the claims that
were submitted for its managed participants and submits the
appropriate information to pharmaceutical manufacturers or
providers in order to obtain volume rebates according to the
contracts it has in place for the services provided. The
pharmaceutical manufacturer or provider may provide to the PBM
volume rebate dollars according to their contractual agreements as
shown in 308. In 309, the PBM may or may not share these rebate
dollars with its clients, typically an employer.
[0049] As described above, the cost savings based on a
therapeutically-equivalent item may be determined on a known
quantity basis. Alternatively, the cost savings may be determined
on a per drug per day basis. One of ordinary skill in the art will
readily recognize that many alternatives exist as a basis for
determining the cost savings.
[0050] An example system in accordance with an embodiment of the
invention is shown in FIG. 4. FIG. 4 shows a block diagram of a
therapeutic alternative program system 100 for facilitating driving
a drug market share, according to embodiments of the invention. In
particular, the therapeutic alternative program system 400 of FIG.
4 includes at least one pharmacy 402, at least one switch provider
404, and at least one pharmaceutical manufacturer or provider 406,
which are each configured for accessing and reading associated
computer-readable media having stored thereon data and/or
computer-executable instructions for implementing the various
methods of the invention. In another embodiment of the invention, a
therapeutic alternative program system 400 of FIG. 4 can include at
least one pharmaceutical benefits manager (PBM) 408, which may be
configured for accessing and reading associated computer-readable
media having stored thereon data and/or computer-executable
instructions for implementing the various methods of the invention.
Generally, network devices and systems, including the one or more
pharmacies 402, switch providers 404, pharmaceutical manufacturers
or providers 406, and pharmaceutical benefits managers (PBM) 408
have hardware and/or software for transmitting and receiving data
and/or computer-executable instructions over a communications link
and a memory for storing data and/or computer-executable
instructions. These network devices and systems may also include a
processor for processing data and executing computer-executable
instructions, as well as other internal and peripheral components
that are well known in the art. As used herein, the term
"computer-readable medium" describes any form of memory or a
propagated signal transmission medium. Propagated signals
representing data and computer-executable instructions are
transferred between network devices and systems.
[0051] As shown in FIG. 4, a pharmacy 402, switch provider 404,
pharmaceutical manufacturer or provider 406, and PBM 408 may be in
direct communication with each other or via a network 410, which as
described below can include one or more private and public
networks, including the Internet. In other embodiments, multiple
pharmacies, switch providers, pharmaceutical manufacturers or
providers, and PBMs may exist. Each of these components--the
pharmacy 402, the switch provider 404, switch provider 404,
pharmaceutical manufacturer or provider 406, PBM 408, and the
network 410--will now be discussed in turn. First. the pharmacy 402
may be any processor-driven device, such as a personal computer,
laptop computer, handheld computer, and the like. In addition to
having a processor 411, the pharmacy 402 may further include a
memory 412, input/output ("I/O") interface(s) 414 and a network
interface 416. The memory 412 may store data files 418 and various
program modules, such as an operating system ("OS") 420 and a
client module 422. The client module 422 may be an Internet browser
or other software, including a dedicated program, for interacting
with the switch provider 404. For example, a user 424, such as a
consumer, pharmacist, or other pharmacy employee, may utilize the
client module 422 in preparing and providing a prescription drug
request or order to the switch provider 404 for processing. The
pharmacy 402 may also utilize the client module 422 to retrieve or
otherwise receive data from the switch provider 404, including
pricing and discount information for the prescription drug request
or order, and pricing and discount information for any alternative
drugs.
[0052] Still referring to the pharmacy 402, the I/O interface(s)
414 facilitate communication between the processor 411 and various
1/O devices, such as a keyboard, mouse, printer, microphone,
speaker, monitor, bar code readers/scanners, RFID readers, and the
like. The network interface 416 may take any of a number of forms,
such as a network interface card, a modem, a wireless network card,
and the like. These and other components of the pharmacy 402 will
be apparent to those of ordinary skill in the art and are therefore
not discussed in more detail herein.
[0053] Similar to the pharmacy 402, the switch provider 404 may
include any processor-driven device that is configured for
receiving, processing, and fulfilling requests from the pharmacy
402 related to pharmacy, benefits, and/or discount transactions,
including those associated with therapeutic alternative program
system. The switch provider 404 may therefore include a processor
426, a memory 428, input/output ("I/O") interface(s) 430, and a
network interface 432. The memory 428 may store data files 434 and
various program modules, such as an operating system ("OS") 436, a
database management system ("DBMS") 438, and the host module 440.
The host module 440 receives, processes, and responds to requests
from the respective client module 422 of pharmacy 402, and further
receives, processes, and responds to requests from the respective
host modules 456, 472 of the pharmacy manufacturer or provider 406
and PBM 408. The switch provider 404 may include additional program
modules for performing other pre-processing or post-processing
methods described herein. Those of ordinary skill in the art will
appreciate that the switch provider 404 may include alternate
and/or additional components, hardware or software.
[0054] As illustrated in FIG. 1, the switch provider 404 may
include or be in communication with at least one data storage
device 442, or databases. If the switch provider 404 includes the
data storage device 442, then the data storage device 442 could
also be part of the memory 428. The data storage device 442 and/or
memory 428 may store, for example, program rules and transaction
records, rebates, and/or discounts associated with prescription
drug requests and orders. The data storage device 442 and/or memory
428 may also store alternative drug information (e.g., equivalent
drug names, equivalent dosage amounts, cost and pricing
information, etc.) for comparing prescription drug requests and
orders. Although a single data storage device 442 is referred to
herein for simplicity, those skilled in the art will appreciate
that multiple physical and/or logical data storage devices or
databases may be used to store the above mentioned data. For
security and performance purposes, the switch provider 404 may have
a dedicated connection to the data storage device 442. However, the
switch provider 404 may also communicate with the data storage
device 442 via a network 410, as shown. In other embodiments of the
invention, the switch provider 404 may include the data storage
device 442 locally. The switch provider 404 may also otherwise be
pat of a distributed or redundant DBMS.
[0055] Similar to the pharmacy 402 and the switch provider 404, the
pharmaceutical manufacturer or provider 406 may include any
processor-driven device that is configured for receiving,
processing, and fulfilling requests from the pharmacy 402 and/or
switch provider related to pharmacy, benefits, and/or discount
transactions, including those associated with the therapeutic
alternative program system. The pharmaceutical manufacturer or
provider 406 may therefore include a processor 442, a memory 444,
input/output ("I/O") interface(s) 446, and a network interface 448.
The memory 444 may store data files 450 and various program
modules, such as an operating system ("O/S") 452, a database
management system ("DBMS") 454, and the host module 456. The host
module 456 receives, processes, and responds to requests from the
client module 422 of pharmacy 402, and further receives, processes,
and responds to requests from the respective host modules 440, 472
of the switch provider 404 and PBM 408. The pharmaceutical
manufacturer or provider 406 may include additional program modules
for performing other pre-processing or post-processing methods
described herein. Those of ordinary skill in the art will
appreciate that the pharmaceutical manufacturer or provider 406 may
include alternate and/or additional components, hardware or
software.
[0056] Similar to the switch provider 404, the pharmaceutical
manufacturer or provider 406 may include or be in communication
with at least one data storage device or database, similar to
442.
[0057] Similar to the pharmacy 402, switch provider 404, and
pharmaceutical manufacturer or provider 406, the PBM 408 may
include any processor-driven device that is configured for
receiving, processing, and fulfilling requests from the pharmacy
402, switch provider 404 and/or pharmaceutical manufacturer or
provider 406 related to pharmacy, benefits, and/or discount
transactions, including those associated with the therapeutic
alternative program system. The PBM 408 may therefore include a
processor 458, a memory 460, input/output ("I/O") interface(s) 462,
and a network interface 464. The memory 460 may store data files
466 and various program modules, such as an operating system ("OS")
468, a database management system ("DBMS") 470, and the host module
472. The host module 472 receives, processes, and responds to
requests from the client module 422 of pharmacy 402, and further
receives, processes, and responds to requests from the respective
host modules 440, 456 of the switch provider 404 and pharmaceutical
manufacturer or provider 406. The PBM 408 may include additional
program modules for performing other pre-processing or
post-processing methods described herein. Those of ordinary skill
in the art will appreciate that the PBM 408 may include alternate
and/or additional components, hardware or software.
[0058] Similar to the switch provider 404, and pharmaceutical
manufacturer or provider 406, the PBM 408 may include or be in
communication with at least one data storage device or database,
similar to 442.
[0059] The network 410 may include any telecommunication and/or
data network, whether public, private, or a combination thereof
including a local area network, a wide area network, an intranet,
an internet, the Internet, intermediate hand-held data transfer
devices, and/or any combination thereof and may be wired and/or
wireless. The network 410 may also allow for real-time, off-line,
and/or batch transactions to be transmitted between the pharmacy
402 and the switch provider 404. Due to network connectivity,
various methodologies as described herein may be practiced in the
context of distributed computing environments. Although the
pharmacy 402 is shown for simplicity as being in communication with
the switch provider 404 via one intervening network 410, it is to
be understood that any other network configuration is possible. For
example, intervening network 410 may include a plurality of
networks, each with devices such as gateways and routers for
providing connectivity between or among networks 410. Instead of or
in addition to a network 410, dedicated communication links may be
used to connect the various devices of the present invention.
[0060] Those of ordinary skill in the art will appreciate that the
therapeutic alternative program system 400 shown in and described
with respect to FIG. 4 is provided by way of example only. Numerous
other operating environments, system architectures, and device
configurations are possible. Accordingly, embodiments of the
invention should not be construed as being limited to any
particular operating environment, system architecture, or device
configuration.
[0061] Embodiments of a therapeutic alternative program system,
such as 400, can facilitate a shift in a drug market share of one
or more pharmaceutical manufacturers or providers. Furthermore,
embodiments of a therapeutic alternative program system, such as
400, can facilitate driving a drug market share of one or more
pharmaceutical manufacturers or providers. The operation of a
therapeutic alternative program system, such as 400 of FIG. 4, and
its various components as well as associated methods and processes
will now be described by reference to FIGS. 5-9.
[0062] FIGS. 5-9 are process flowcharts illustrating example
methods in accordance with embodiments of the invention. The
example method 500 shown in FIG. 5 provides a method for
facilitating a shift in drug market share. The method 500 can be
implemented by a therapeutic alternative program system, such as
400 of FIG. 4.
[0063] The method 500 begins at block 502. In block 502,
prescription drug information associated with a consumer is
received. For example, as shown in FIG. 4, prescription drug
information associated with a consumer, such as 424, can be
received by a pharmacy 402 via an I/O interface 414 and/or client
module 422. The processor 411 associated with the pharmacy 402 can
receive the prescription drug information and process and/or
transmit the information as needed.
[0064] Block 502 is followed by block 504, in which based at least
in part on the prescription drug information, at least one
alternative drug and cost savings information associated with
purchasing the alternative drug in lieu of a prescription drug
associated with the prescription drug information are determined.
For example, as shown in FIG. 4, a processor 411 can transmit the
information via the network to a switch provider 404. The processor
426 associated with the switch provider 404 can determine one or
more alternative drugs and calculate the cost savings by utilizing
the difference in the alternative drug price and the price for a
requested prescription drug. In one embodiment, the processor 426
can access a data storage device or database, such as 442, to
obtain information associated with alternative drugs and the
prescription drug.
[0065] In one embodiment, true prices for alternative drugs and a
requested prescription drug can be calculated by using one or more
discount rules. Examples of discount rules can include, but are not
limited to, 100% co-pay plan rules for discounts, available
manufacturer or provider rebates, coupons, vouchers, patient
assistance, or similar price reduction methodologies associated
with each. Based on the true prices, the processor 426 can
calculate the cost savings.
[0066] Block 504 is followed by block 506, in which the identity of
the alternative drug and cost savings information are provided for
review by an entity. For example, as shown in FIG. 4, the processor
426 can transmit results via the network 410 to the pharmacy 402.
The processor 411 associated with the pharmacy 402 can output the
identity of the alternative drug and cost saving information via
the I/0 interface 414 and/or the client module 422. A consumer,
such as 424, or other entity can review the identity of the
alternative drug and cost savings information, including the name
of a therapeutically equivalent drug, dosage, and cost savings, and
the consumer 424 can make a decision regarding the selection of the
alternative drug.
[0067] In one embodiment, an entity can be a pharmaceutical
benefits manager, such as 408. For example, as shown in FIG. 4, the
pharmacy 402 can transmit the identity of the alternative drug and
cost savings information to the pharmaceutical benefits manager 408
for review. The processor 458 associated with the pharmaceutical
benefits manager 408 can output the identity of the alternative
drug and cost saving information via the I/O interface 462 and/or
the host module 472. A person, such as 424, or other entity can
review the identity of the alternative drug and cost savings
information, and make a decision regarding the selection of the
alternative drug.
[0068] Block 506 is followed by block 508, in which decision
information associated with the consumer is received, wherein the
decision information includes a decision to switch from the
prescription drug to the alternative drug. For example, as shown in
FIG. 4, a consumer, such as 424, can input decision information via
the I/O interface 414 and/or the client module 422. The decision
information, including a decision to switch from the prescription
drug to the alternative drug, can be transmitted to the processor
411 for further processing.
[0069] In another embodiment, decision information can be input via
the I/O interface 462 and/or the host module 472 associated with
the pharmaceutical benefits manager 408. The decision information,
including a decision to switch from the prescription drug to the
alternative drug, can be transmitted to the processor 458 for
further processing.
[0070] Block 508 is followed by block 510 in which at least a
portion of the decision information is provided to at least one
provider associated with the alternative drug. For example, as
shown in FIG. 4, the processor 411 can transmit via the network 410
to a pharmaceutical manufacturer or provider 406 some or all of the
decision information received from the consumer 424. In another
embodiment, the processor 426 associated with the switch provider
404 can transmit via the network 410 to a pharmaceutical
manufacturer or provider 406 some or all of the decision
information received from the consumer 424. In some instances, the
processor 411, 426 may capture all data elements necessary from
various pharmacy participants and compile it into a format that
will provide information concerning market share shifts attained
for specific drug entities for which pharmaceutical manufacturers
or providers 406 have contracted to provide volume rebates for such
shifts.
[0071] Block 510 is followed by block 512, in which new pricing
information associated with the alternative drug is received. For
example, as shown in FIG. 4, the processor 442 associated with
pharmaceutical manufacturer or provider 406 can receive some or all
of the decision information associated with the consumer, and the
processor 442 can determine whether the drug is eligible for a
price reduction. If a particular drug is eligible for a rebate, the
processor 442 can determine the appropriate rebate and transmit
suitable pricing information via the network 410 to the pharmacy
402. In addition, the processor 442 can determine any rebate
revenues for the pharmacy 402 or other pharmacy participants in
accordance with any contractual agreements, such as between a
pharmacy 402 and a pharmaceutical manufacturer or provider 406. The
processor 442 can provide suitable rebate information via the
network 410 to the switch provider 404, such that the switch
provider 404 can determine or otherwise apportion any rebate
revenues payable to the pharmacy 402 or other pharmacy
participants.
[0072] The method 500 of FIG. 5 ends at block 510.
[0073] The example method 600 shown in FIG. 6 provides a method for
facilitating a shift in drug market share. The method 600 can be
implemented by a therapeutic alternative program system, such as
400 of FIG. 4.
[0074] The method 600 begins at block 602. In block 602, a message
from a pharmacy is received, wherein the message includes
information identifying a requested drug. For example, as shown in
FIG. 4, prescription drug information associated with a consumer,
such as 424, can be received by a pharmacy 402 via an I/O interface
414 and/or client module 422. The processor 411 associated with the
pharmacy 402 can receive the prescription drug information and
process and/or transmit the information as needed.
[0075] Block 602 is followed by block 604, in which one or more
alternative drugs for the requested drug are identified, wherein
the alternative drugs have substantially similar therapeutic
effects as the requested drug. For example, as shown in FIG. 4, a
processor 411 can transmit the information via the network to a
switch provider 404. The processor 426 associated with the switch
provider 404 can determine one or more alternative drugs, and
compare the prices of an alternative drug and the price for the
requested prescription drug. In one embodiment, the processor 426
can access a data storage device or database, such as 442, to
obtain information associated with alternative drugs and the
requested prescription drug.
[0076] In one embodiment, true prices for alternative drugs and a
requested prescription drug can be calculated by using one or more
discount rules. Examples of discount rules can include, but are not
limited to, 100% co-pay plan rules for discounts, available
manufacturer or provider rebates, coupons, vouchers, patient
assistance, or similar price reduction methodologies associated
with each. Based on the true prices, the processor 426 can
calculate the cost savings.
[0077] Block 604 is followed by block 606, in which a determination
is made that at least one of the identified alternative drugs is
priced at a lower price than the requested drug. For example, as
shown in FIG. 4, based on the processor 426 can determine that at
least one identified alternative drug is priced relatively lower
than the requested drug.
[0078] Block 606 is followed by block 608, in which an indication
is transmitted of the availability of at least one alternative drug
and pricing information associated with the at least one
alternative drug. For example, as shown in FIG. 4, the processor
426 can transmit an indication via the network 410 to the pharmacy
402. The processor 426 can transmit the identity of the alternative
drug, price, and in some instances, associated cost saving
information, via the I/O interface 414 and/or the client module
422. A consumer, such as 424, or other entity can review the
identity of the alternative drug and cost savings information,
including the name of a therapeutically equivalent drug, dosage,
and cost savings, and the consumer 424 can make a decision
regarding the selection of the alternative drug.
[0079] In one embodiment, an entity can be a pharmaceutical
benefits manager, such as 408. For example, as shown in FIG. 4, the
processor 426 can transmit an indication via the network 410 to the
pharmaceutical benefits manager 408 for review. The processor 458
associated with the pharmaceutical benefits manager 408 can output
the identity of the alternative drug, price, and in some instances,
cost saving information, via the I/O interface 462 and/or the host
module 472. A person, such as 424, or other entity can review the
identity of the alternative drug, price, and in some instances,
cost savings information, and make a decision regarding the
selection of the alternative drug.
[0080] The method 600 of FIG. 6 ends at block 608.
[0081] The example method 700 shown in FIG. 7 provides a method for
obtaining an alternative to a prescription drug from a pharmacy.
The method 700 can be implemented by a consumer, such as 424 of
FIG. 4, in conjunction with a therapeutic alternative program
system, such as 400.
[0082] The method 700 begins at block 702. In block 702, a
prescription drug is requested from a therapeutic alternative
program. For example, as shown in FIG. 4, a request for a
prescription drug can be requested by a consumer, such as 424. The
request can be received by a pharmacy 402 via an I/O interface 414
and/or client module 422. The processor 411 associated with the
pharmacy 402 can receive the prescription drug request and process
and/or transmit the request as needed.
[0083] Block 702 is followed by block 704, in which information
identifying one or more alternative drugs is received from the
therapeutic alternative program, wherein each of the alternative
drugs has substantially similar therapeutic effects as the
prescription drug. For example, as shown in FIG. 4, a processor 411
can transmit the request via the network to a switch provider 404.
The processor 426 associated with the switch provider 404 can
determine one or more alternative drugs that have substantially
similar therapeutic effects as the requested prescription drug.
[0084] Block 704 is followed by block 706, in which information
associated with a price savings is received from the therapeutic
alternative program. For example, as shown in FIG. 4, the processor
426 associated with the switch provider 404 can calculate a price
or cost savings by utilizing the difference in the alternative drug
price and the price for a requested prescription drug. In one
embodiment, the processor 426 can access a data storage device or
database, such as 442, to obtain information associated with
alternative drugs and the requested prescription drug.
[0085] In one embodiment, true prices for alternative drugs and the
requested prescription drug can be calculated by using one or more
discount rules. Examples of discount rules can include, but are not
limited to, 100% co-pay plan rules for discounts, available
manufacturer or provider rebates, coupons, vouchers, patient
assistance, or similar price reduction methodologies associated
with each. Based on the true prices, the processor 426 can
calculate the cost savings.
[0086] In any instance, the processor 426 can transmit results via
the network 410 to the pharmacy 402. The processor 411 associated
with the pharmacy 402 can output the identity of the alternative
drug and cost saving information via the I/O interface 414 and/or
the client module 422. A consumer, such as 424, or other entity can
review the identity of the alternative drug and cost savings
information, including the name of a therapeutically equivalent
drug, dosage, and cost savings, and the consumer 424 can make a
decision regarding the selection of the alternative drug.
[0087] In one embodiment, an entity can be a pharmaceutical
benefits manager, such as 408. For example, as shown in FIG. 4, the
pharmacy 402 can transmit the identity of the alternative drug and
cost savings information to the pharmaceutical benefits manager 408
for review. The processor 458 associated with the pharmaceutical
benefits manager 408 can output the identity of the alternative
drug and cost saving information via the I/O interface 462 and/or
the host module 472. A person, such as 424, or other entity can
review the identity of the alternative drug and cost savings
information, and make a decision regarding the selection of the
alternative drug.
[0088] Block 706 is followed by block 708, in which a switch
request is transmitted to the therapeutic alternative program,
wherein the switch request comprises a request for at least one
alternative drug in lieu of the initially requested prescription
drug. For example, as shown in FIG. 4, a consumer, such as 424, can
input a switch request via the I/O interface 414 and/or the client
module 422. The switch request, including a decision to switch from
the prescription drug to the alternative drug, can be transmitted
to the processor 411 for further processing.
[0089] In another embodiment, a switch request can be input via the
I/O interface 462 and/or the host module 472 associated with the
pharmaceutical benefits manager 408. The switch request, including
a decision to switch from the prescription drug to the alternative
drug, can be transmitted to the processor 458 for further
processing.
[0090] The method 700 of FIG. 7 ends at block 708.
[0091] The example method 800 shown in FIG. 8 provides a method for
facilitating a shift in drug market share. The method 800 can be
implemented by a therapeutic alternative program system, such as
400 of FIG. 4.
[0092] The method 800 begins at block 802. In block 802, one or
more drugs are offered to a pharmacy at an initial price, wherein
the drugs can be used to fill prescriptions associated with
consumers. For example, as shown in FIG. 4, a pharmaceutical
manufacturer or provider 406 can provide or otherwise offer one or
more drugs to a pharmacy 402 to fill prescriptions requested by
consumers, such as 424.
[0093] Block 802 is followed by block 804, in which a rebate
program is established with the pharmacy to provide a price
reduction for a prescribed drug based on a predefined shift in
market share. For example, as shown in FIG. 4, the pharmaceutical
manufacturer or provider 406 can contractually agree with one or
more pharmacies, such as 402, to provide price reductions for the
drugs based on a predefined shift in market share. In one
embodiment, one or more predefined discount rules can be
implemented by and between a pharmaceutical manufacturer or
provider 406 and pharmacy 402 to provide a price reduction for at
least one drug based at least in part on a particular shift in
market share for a particular drug or drugs.
[0094] Block 804 is followed by block 806, in which information
associated with a shift in market share for one of the drugs is
received from a therapeutic alternative program. For example, as
shown in FIG. 4, after decision information or switch request
information is received by the processor 411, the decision
information, including a decision to switch from the prescription
drug to the alternative drug, can be transmitted via the network
410 to a pharmaceutical manufacturer or provider 406 some or all of
the decision information received from the consumer 424. In another
embodiment, the processor 426 associated with the switch provider
404 can transmit via the network 410 to a pharmaceutical
manufacturer or provider 406 some or all of the decision
information received from the consumer 424. In some instances, the
processor 411, 426 may capture all data elements necessary from
various pharmacy participants and compile it into a format that
will provide information concerning market share shifts attained
for specific drug entities for which pharmaceutical manufacturers
or providers 406 have contracted to provide volume rebates for such
shifts.
[0095] Block 806 is followed by block 808, in which based at least
in part on the shift in market share, a determination is made
whether the drug is eligible for a price reduction. For example, as
shown in FIG. 4, the processor 442 associated with pharmaceutical
manufacturer or provider 406 can receive some or all of the
decision information associated with the consumer, and the
processor 442 can determine whether the drug is eligible for a
price reduction. The processor 442 can use predefined volume
amounts, contractually defined volume amounts, drug sales data, or
any other criteria to determine if a particular drug is eligible
for a price reduction. In other embodiments, other components, such
as processors 411, 426, and 458 can similarly determine eligibility
for a price reduction.
[0096] Block 806 is followed by block 810, in which if the drug is
eligible for a rebate, the drug is offered to the pharmacy at a
reduced price, wherein the drug can be used to fill a prescription
requested by a consumer. For example, as shown in FIG. 4, if a
particular drug is eligible for a rebate, the processor 442 can
determine the appropriate rebate and transmit suitable pricing
information via the network 410 to the pharmacy 402. In turn, the
pharmacy 402 can provide the drug at the reduced price to
consumers. In addition, the processor 442 can determine any rebate
revenues for pharmacy participants in accordance with any
contractual agreements, such as between a pharmacy 402 and a
pharmaceutical manufacturer or provider 406. The processor 442 can
provide suitable rebate information via the network 410 to the
switch provider, such that the switch provider 404 can determine or
otherwise apportion any rebate revenues payable to a pharmacy 402
or other pharmacy participants.
[0097] The method 800 of FIG. 8 ends at block 810.
[0098] The example method 900 shown in FIG. 9 provides a method for
enhancing revenues of a pharmacy. The method 900 can be implemented
by a therapeutic alternative program system, such as 400 of FIG.
4.
[0099] The method 900 begins at block 902. In block 902, a customer
program is established at a pharmacy for cash customers. For
example, as shown in FIG. 4, a pharmacy 402 and/or a pharmaceutical
manufacturer or provider 406 can provide or otherwise offer a
customer program to consumers, such as 424, who purchase one or
more drugs with cash to fill prescriptions.
[0100] Block 902 is followed by block 904, in which one or more
program rules can be provided for the customer program, wherein at
least one program rule specifies at least an amount of a discount
for one or more drugs. For example, as shown in FIG. 4, the
pharmaceutical manufacturer or provider 406 can contractually agree
with one or more pharmacies, such as 402, to provide price
reductions for the drugs based on a predefined shift in market
share. In one embodiment, one or more predefined discount rules can
be implemented by and between a pharmaceutical manufacturer or
provider 406 and pharmacy 402 to provide a price reduction for at
least one drug based at least in part on a particular shift in
market share for a particular drug or drugs.
[0101] Block 904 is followed by block 906, in which at least one
drug order is received from a cash customer at the pharmacy. For
example, as shown in FIG. 4, a request for a prescription drug can
be requested by a consumer, such as 424. The request can be
received by a pharmacy 402 via an I/O interface 414 and/or client
module 422. The processor 411 associated with the pharmacy 402 can
receive the prescription drug request and process and/or transmit
the request as needed.
[0102] Block 906 is followed to block 908, in which the drug order
is provided to a switch provider. For example, as shown in FIG. 4,
a processor 411 associated with the pharmacy 402 can transmit the
information via the network to a switch provider 404.
[0103] Block 908 is followed by block 910, in which one or more
alterative drugs for the drug associated with the drug order is
identified, wherein the alternative drugs have substantially
similar therapeutic effects as the drug associated with the drug
order. For example, as shown in FIG. 4, the processor 426
associated with the switch provider 404 can determine one or more
alternative drugs that have a similar therapeutic effects as the
drug associated with the drug order. In one embodiment, the
processor 426 can access a data storage device or database, such as
442, to obtain information associated with alternative drugs and
the prescription drug.
[0104] Block 910 is followed by block 912, in which one or more of
the identified alternative drugs are determined to be priced at a
lower price than the drug associated with the drug order, wherein
the prices for the alternative drugs are based at least in part on
one or more of the program rules. For example, as shown in FIG. 4,
the processor 426 associated with the switch provider 404 can
determine and compare the prices for the alternative drugs and the
price for a requested prescription drug. In one embodiment, the
processor 426 can access a data storage device or database, such as
442, to obtain information associated with alternative drugs and
the prescription drug.
[0105] In one embodiment, true prices for alternative drugs and a
requested prescription drug can be calculated by using one or more
discount rules. Examples of discount rules can include, but are not
limited to, 100% co-pay plan rules for discounts, available
manufacturer or provider rebates, coupons, vouchers, patient
assistance, or similar price reduction methodologies associated
with each.
[0106] Block 912 is followed by block 914, in which an indication
of availability of one or more alternative drugs and pricing
information associated with the one or more alternative drugs is
transmitted to the pharmacy. For example, as shown in FIG. 4, the
processor 426 can transmit results via the network 410 to the
pharmacy 402. The processor 411 associated with the pharmacy 402
can output the identity of the alternative drug and pricing
information via the 1/O interface 414 and/or the client module 422.
A consumer, such as 424, or other entity can review the identity of
the alternative drug and pricing information, including the name of
a therapeutically equivalent drug, dosage, and cost savings, and
the consumer 424 can make a decision regarding the selection of the
alternative drug.
[0107] The method 900 of FIG. 9 ends at block 914.
[0108] The example elements and steps of FIGS. 5-9 are shown by way
of example, and other process embodiments can have fewer or greater
numbers of elements or steps, and such elements or steps can be
arranged in alternative configurations in accordance with other
embodiments of the invention.
[0109] Many modifications and other embodiments of the invention
will come to mind to one skilled in the art to which this invention
pertains having the benefit of the teachings presented in the
foregoing descriptions and the associated drawings. Therefore, it
is to be understood that the invention is not to be limited to the
specific embodiments disclosed and that modifications and other
embodiments are intended to be included within the scope of the
appended claims. Although specific terms are employed herein, they
are used in a generic and descriptive sense only and not for
purposes of limitation.
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