U.S. patent application number 17/081854 was filed with the patent office on 2021-02-18 for system and method for managing selection of prescription drug plans.
This patent application is currently assigned to Truveris, Inc.. The applicant listed for this patent is Truveris, Inc.. Invention is credited to Kristin Begley, Leon Greene, Anthony J. Loiacono, Tom Staloch.
Application Number | 20210049661 17/081854 |
Document ID | / |
Family ID | 1000005190730 |
Filed Date | 2021-02-18 |
United States Patent
Application |
20210049661 |
Kind Code |
A1 |
Begley; Kristin ; et
al. |
February 18, 2021 |
System And Method For Managing Selection Of Prescription Drug
Plans
Abstract
A system and method for managing selection of a prescription
drug plan, based on generating a request for proposal (RFP),
submitting the RFP to prescription benefit management (PBM)
vendors, receiving bids from PBM vendors, and calculating weighted
scores of the bids to determine total score for the plan.
Inventors: |
Begley; Kristin; (New York,
NY) ; Greene; Leon; (Jersey City, NJ) ;
Loiacono; Anthony J.; (Bayonne, NJ) ; Staloch;
Tom; (Prior Lake, MN) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Truveris, Inc. |
New York |
NY |
US |
|
|
Assignee: |
Truveris, Inc.
New York
NY
|
Family ID: |
1000005190730 |
Appl. No.: |
17/081854 |
Filed: |
October 27, 2020 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13999121 |
Jan 16, 2014 |
10817920 |
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17081854 |
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61753530 |
Jan 17, 2013 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
G06Q 10/10 20130101;
G06Q 50/22 20130101; G16H 20/00 20180101; G06Q 30/0611 20130101;
G16H 40/20 20180101; G06Q 40/08 20130101; G16H 50/70 20180101 |
International
Class: |
G06Q 30/06 20060101
G06Q030/06; G16H 40/20 20060101 G16H040/20; G16H 50/70 20060101
G16H050/70; G16H 20/00 20060101 G16H020/00; G06Q 10/10 20060101
G06Q010/10; G06Q 40/08 20060101 G06Q040/08; G06Q 50/22 20060101
G06Q050/22 |
Claims
1. A computer-implemented method performed by a computer system for
supporting an entity with selection of a prescription drug plan,
said method comprising: receiving a request to initiate a request
for proposal (RFP) process from a particular remote client system
of a plurality of remote client systems, the request to initiate
the RFP process being for a prescription drug plan for a particular
entity; obtaining a particular set of historical drug claims for
the particular entity from a remote database; generating an RFP for
the particular entity for the prescription drug plan based on the
particular set of historical drug claims obtained from the remote
database; distributing said RFP to a plurality of remote vendor
systems to participate in submission of a bid in response to said
RFP; receiving one or more bids containing pricing information and
contract terms from one or more of said plurality of remote vendor
systems, the pricing information comprising respective pricing
terms corresponding to one or more drug claims, the one or more
bids each including a corresponding vendor-indicated drug
classification for each drug claim of the one or more drug claims;
obtaining, from one or more third party systems, data indicators
indicating third-party-indicated drug classifications for the
historical drug claims of the particular set of historical drug
claims, the third-party-indicated drug classifications including a
generic drug classification, a brand drug classification, and a
specialty drug classification, the third party systems being
different than the remote database, the particular remote client
system and the plurality of remote vendor systems; classifying each
historical drug claim of the particular set of historical drug
claims into one or more third-party-indicated drug classifications
of the third-party-indicated drug classifications based on the data
indicators, the classifying disregarding the corresponding
vendor-indicated drug classification; obtaining, from the one or
more third-party systems, price inflation parameters and
utilization inflation parameters for each third-party-indicated
drug classification of the one or more third-party-indicated drug
classifications; obtaining historical utilization data associated
with the particular set of historical drug claims; using the
particular set of historical drug claims from the remote database
to project costs forward by applying the price inflation parameters
to the pricing information of each bid of said one or more bids
based on the one or more third-party-indicated drug
classifications, and applying the utilization inflation parameters
to the historical utilization data associated with the particular
set of historical drug claims; calculating a corresponding
estimated plan cost for each bid of the one or more bids based on
the projecting costs forward, the corresponding estimated plan cost
of each bid of the one or more bids having accounted for price
inflation and utilization inflation based on the same price
inflation parameters, the same utilization inflation parameters,
and the same third-party-indicated drug classifications; generating
scores for each bid of said one or more bids based on the
corresponding estimated plan cost; and sending at least one bid of
the one or more bids and at least one score of the scores to said
particular remote client system to support selection of the drug
prescription plan from the one or more bids.
2. The computer-implemented method of claim 1, wherein said
plurality of remote vendor systems selected to participate in
submission of said bid are identified by said plurality of remote
client systems.
3. The computer-implemented method of claim 1, wherein said price
inflation parameters are set separately for each year of
projection.
4. The computer-implemented method of claim 1, wherein scoring each
of said one or more bids comprises at least two scoring elements,
wherein a first scoring element is associated with plan costs and a
second scoring element is associated with plan terms and
definitions.
5. The computer-implemented method of claim 4, wherein said first
scoring element and said second scoring element are represented by
weighted scoring values.
6. The computer-implemented method of claim 1, further comprising,
after the receiving the one or more bids, determining if at least
one bid of the one or more bids is approved, and if a particular
bid of the at least one bid is not approved, transmitting a request
for a revised bid to a subset of said plurality of remote vendor
systems.
7. The computer-implemented method of claim 6, further comprising
re-scoring revised bids received from said subset of said plurality
of remote vendor systems.
8. The computer-implemented method of claim 1, further comprising,
after the scoring each of said one or more bids, if an inadequate
score is determined, transmitting a request for a revised bid to a
subset of said plurality of remote vendor systems.
9. The computer-implemented method of claim 1, wherein one or more
prevailing bids are selected from bids comprising significantly
favorable projected-cost structures, market competitive benefits,
and enhanced cost savings over a projected period of time.
10. The computer-implemented method of claim 1, further comprising:
receiving one or more bid scenarios from a particular remote vendor
system of the one or more of said plurality of remote vendor
systems, each of said one or more bid scenarios including
particular pricing information and particular contract terms being
considered as a particular bid to be submitted; and providing one
or more particular estimated plan cost responses to the particular
remote vendor system as feedback to the received one or more bid
scenarios.
11. The computer-implemented method of claim 1, wherein the
particular entity initiated the RFP process.
12. The computer-implemented method of claim 1, wherein the
particular entity is not associated with an associated entity that
initiated the RFP process.
13. A computer system for supporting an entity with a request for
proposal (RFP), comprising: memory storing program instructions;
one or more processors coupled to said memory, wherein when
executing the program instructions the one or more processors is
configured to: receive a request to initiate a request for proposal
(RFP) process from a particular remote client system of a plurality
of remote client systems, the request to initiate the RFP process
being for a prescription drug plan for a particular entity; obtain
a particular set of historical drug claims for the particular
entity from a remote database; generate an RFP for the particular
entity for the prescription drug plan based on the particular set
of historical drug claims from the remote database; distribute said
RFP to a plurality of remote vendor systems to participate in
submission of a bid in response to said RFP; receive one or more
bids containing pricing information and contract terms from one or
more of said plurality of remote vendor systems, the pricing
information comprising respective pricing terms corresponding to
one or more drug claims, the one or more bids each including a
corresponding vendor-indicated drug classification for each drug
claim of the one or more drug claims; obtain, from one or more
third party systems, data indicators indicating
third-party-indicated drug classifications for the historical drug
claims of the particular set of historical drug claims, the
third-party-indicated drug classifications including a generic drug
classification, a brand drug classification, and a specialty drug
classification, the third party systems being different than the
remote database, the particular remote client system and the
plurality of remote vendor systems; classify each historical drug
claim of the particular set of historical drug claims into one or
more third-party-indicated drug classifications of the
third-party-indicated drug classifications based on the data
indicators, the classifying disregarding the corresponding
vendor-indicated drug classification; obtain, from the one or more
third-party systems, price inflation parameters and utilization
inflation parameters for each third-party-indicated drug
classification of the one or more third-party-indicated drug
classifications; obtain historical utilization data associated with
the particular set of historical drug claims; use the particular
set of historical drug claims from the remote database to project
costs forward by applying the price inflation parameters to the
pricing information of each bid of said one or more bids based on
the one or more third-party-indicated drug classifications, and
applying the utilization inflation parameters to the historical
utilization data associated with the particular set of historical
drug claims; calculate a corresponding estimated plan cost for each
bid of the one or more bids based on the projecting costs forward,
the corresponding estimated plan cost of each bid of the one or
more bids having accounted for price inflation and utilization
inflation based on the same price inflation parameters, the same
utilization inflation parameters, and the same
third-party-indicated drug classifications; generate scores for
each bid of said one or more bids based on the corresponding
estimated plan cost; and send at least one bid of the one or more
bids and at least one score of the scores to said particular remote
client system to support selection of the drug prescription
plan.
14. A non-transitory computer-readable storage medium programmed to
include instructions that, when executed by a processing device,
cause the processing device to perform a method of managing a
request for proposal, said method comprising: receiving a request
to initiate a request for proposal (RFP) process from a particular
remote client system of a plurality of remote client systems, the
request to initiate the RFP process being for a prescription drug
plan for a particular entity; obtaining a particular set of
historical drug claims for the particular entity from a remote
database; generating an RFP for the particular entity for the
prescription drug plan based on the particular set of historical
drug claims obtained from the remote database; distributing said
RFP to a plurality of remote vendor systems to participate in
submission of a bid in response to said RFP; receiving one or more
bids containing pricing information and contract terms from one or
more of said plurality of remote vendor systems, the pricing
information comprising respective pricing terms corresponding to
one or more drug claims, the one or more bids each including a
corresponding vendor-indicated drug classification for each drug
claim of the one or more drug claims; obtaining, from one or more
third party systems, data indicators indicating
third-party-indicated drug classifications for the historical drug
claims of the particular set of historical drug claims, the
third-party-indicated drug classifications including a generic drug
classification, a brand drug classification, and a specialty drug
classification, the third party systems being different than the
remote database, the particular remote client system and the
plurality of remote vendor systems; classifying each historical
drug claim of the particular set of historical drug claims into one
or more third-party-indicated drug classifications of the
third-party-indicated drug classifications based on the data
indicators, the classifying disregarding the corresponding
vendor-indicated drug classification; obtaining, from the one or
more third-party systems, price inflation parameters and
utilization inflation parameters for each third-party-indicated
drug classification of the one or more third-party-indicated drug
classifications; obtaining historical utilization data associated
with the particular set of historical drug claims; using the
particular set of historical drug claims from the remote database
to project costs forward by applying the price inflation parameters
to the pricing information of each bid of said one or more bids
based on the one or more third-party-indicated drug
classifications, and applying the utilization inflation parameters
to the historical utilization data associated with the particular
set of historical drug claims; calculating a corresponding
estimated plan cost for each bid of the one or more bids based on
the projecting costs forward, the corresponding estimated plan cost
of each bid of the one or more bids having accounted for price
inflation and utilization inflation based on the same price
inflation parameters, the same utilization inflation parameters,
and the same third-party-indicated drug classifications; generating
scores for each bid of said one or more bids based on the
corresponding estimated plan cost; and sending at least one bid of
the one or more bids and at least one score of the scores to said
particular remote client system to support selection of the drug
prescription plan from the one or more bids.
Description
CROSS REFERENCE TO RELATED APPLICATION
[0001] This application is a continuation of and claims priority to
U.S. patent application Ser. No. 13/999,121 filed Jan. 16, 2014,
entitled "System And Method For Managing Selection Of Prescription
Drug Plans," now U.S. Pat. No. 10,817,920, which claims the benefit
under 35 U.S.C. 119(e) of U.S. Patent Application No. 61/753,530,
filed Jan. 17, 2013, which are hereby incorporated by reference
herein in their entirety.
FIELD OF THE INVENTION
[0002] Embodiments of the invention relate generally to
prescription drug plans and, more specifically, to electronic
management of a request for proposal (RFP) and corresponding bids
for selecting a prescription drug plan.
BACKGROUND OF THE INVENTION
[0003] Presently, sponsors of pharmacy benefit management plans
typically enter into a request for proposal ("RFP") process every
few years in order to maintain market competitive benefits, which
may be valued at $5 Million to $500 Million in plan spend per year.
This process entails a solicitation of competitive bids from
Pharmacy Benefit Manager ("PBM") vendors serving the marketplace
and an evaluation of the submitted proposals. A problem that arises
with current implementations of RFPs is that plan sponsors
(business entities, corporations, etc. with health- and
medical-insurable employees) are reliant upon the cost projections
provided by the PBM vendors, which often do not fairly or
accurately represent the value of the bids being presented.
[0004] Due to the complexities associated with the pharmacy benefit
industry and pricing methodologies for prescription drugs,
evaluation of PBM bids are typically subject to the calculations or
stated cost projections provided by the vendors themselves. Pricing
calculations are reliant upon specialized industry knowledge,
highly technical algorithmic pricing calculations, subjective cost
projection methodologies, powerful computer processing equipment,
and subscription to third party data services for clinical and
pricing classification data required to calculate pharmacy claims
cost according to bid terms. Absent the aforementioned elements,
calculating the costs of any one RFP bid, much less a multitude of
bids typically submitted by various PBM vendors in the course of an
RFP process, can not be done in a reasonable period of time to
provide maximum savings to clients and patients.
[0005] Furthermore, due to the interpretive nature of contract
language, PBM bid contract terms may be manipulated through
subtlety in language and nuance in terminology, which cannot be
fairly assessed to compare vendor RFP submissions. As a result, RFP
submissions are highly subjective and prone to manipulation by PBM
vendors and bids cannot be fairly or objectively assessed by even
the most knowledgeable industry professionals and data analysts due
to the unmanageably large claims data sets, complex calculations
involving determinations of drug classification and application of
pricing terms, reliance upon costly subscription services for third
party data elements, and variety of terms and pricing proposals
provided in the limited period of time allowed to complete an RFP
process.
[0006] By so structuring the bids, PBMs thrive upon a bid process
in which the plan sponsors are unable to assess the relative value
of the proposed contracts in objective terms and are reliant upon
the bidder's own projections. As such, a solution is required to
provide an improved method for conducting PBM request for proposals
and calculating the projected costs of the plan subject to RFP bid
terms and pricing proposals, resulting in an unbiased assessment of
deal terms and pricing projections, presented on a consistent basis
across RFP submissions.
BRIEF DESCRIPTION OF THE DRAWINGS
[0007] The present invention is illustrated by way of example, and
not by way of limitation, and will become apparent upon
consideration of the following detailed description, taken in
conjunction with the accompanying drawings, in which like reference
characters refer to like parts throughout, and in which:
[0008] FIG. 1 is a block diagram illustrating an exemplary computer
network in which embodiments of the present invention may
operate.
[0009] FIG. 2 is a block diagram illustrating exemplary components
enabling an RFP management platform, as illustrated in the
exemplary computer network of FIG. 1.
[0010] FIG. 3 is a flow diagram illustrating an embodiment of a
method for managing a request for proposal (RFP) between a client
entity and prescription benefit managers (PBMs).
[0011] FIG. 4 is a flow diagram illustrating an embodiment of a
method for generating an RFP.
[0012] FIG. 5 is a flow diagram illustrating an embodiment of a
method for constructing a bid in response to an RFP.
[0013] FIG. 6 is a flow diagram illustrating an embodiment of a
method for implementing an adjudication process.
[0014] FIG. 7 is a flow diagram illustrating an embodiment of a
method for implementing a scoring process.
[0015] FIG. 8 illustrates a diagrammatic representation of a
machine in the exemplary form of a computer system.
SUMMARY OF THE INVENTION
[0016] The present invention relates to a computer-implemented
system and method for managing a request for proposal (RFP), said
method characterized by:
[0017] generating, using a programmed computer, said RFP for a
client entity;
[0018] distributing, using said programmed computer, said RFP to a
plurality of respondent entities selected to participate in
submission of a bid for said RFP;
[0019] receiving an electronic confirmation from one or more of
said plurality of respondent entities acknowledging participation
in submitting said bid for said RFP;
[0020] receiving, using said programmed computer, bids from said
plurality of respondent entities having acknowledged
participation;
[0021] adjudicating, using said programmed computer, each of said
bids received to provide a standardized comparison between said
bids;
[0022] projecting, using said programmed computer, costs forward by
applying inflation parameters across each of said bids for claim
sets associated with said RFP;
[0023] scoring, using said programmed computer, each of said bids;
and
[0024] presenting, using said programmed computer, one or more
prevailing bids to said client entity.
DETAILED DESCRIPTION
[0025] Embodiments of the invention provide methods for managing
selection of prescription drug plans.
[0026] In the following description, numerous details are set
forth. It will be apparent, however, to one skilled in the art,
that the present invention may be practiced without these specific
details. In some instances, well-known structures and devices are
shown in block diagram form, rather than in detail, in order to
avoid obscuring the present invention.
[0027] Some portions of the detailed descriptions are presented in
terms of algorithms and symbolic representations of operations on
data bits within a computer memory. These algorithmic descriptions
and representations are the means used by those skilled in the data
processing arts to most effectively convey the substance of their
work to others skilled in the art. An algorithm is here, and
generally, conceived to be a self-consistent sequence of steps
leading to a desired result. The steps are those requiring physical
manipulations of physical quantities. Usually, though not
necessarily, these quantities take the form of electrical or
magnetic signals capable of being stored, transferred, combined,
compared, and otherwise manipulated. It has proven convenient at
times, principally for reasons of common usage, to refer to these
signals as bits, values, elements, symbols, characters, terms,
numbers, or the like.
[0028] It should be borne in mind, however, that all of these and
similar terms are to be associated with the appropriate physical
quantities and are merely convenient labels applied to these
quantities. Unless specifically stated otherwise, as apparent from
the above discussion, it is appreciated that throughout the
description, discussions utilizing terms such as "initiating",
"receiving", "determining", "generating", "constructing",
"transmitting", "adjudicating", "scoring", "calculating",
"processing", "presenting" or the like, refer to the action and
processes of a computer system, or similar electronic computing
device, that manipulates and transforms data represented as
physical (electronic) quantities within the computer system's
registers and memories into other data similarly represented as
physical quantities within the computer system memories or
registers or other such information storage, transmission or
display devices.
[0029] The present invention also relates to an apparatus for
performing the operations herein. This apparatus may be specially
constructed for the required purposes or it may comprise a general
purpose computer selectively activated or reconfigured by a
computer program stored in the computer. Such a computer program
may be stored in a computer readable storage medium, such as, but
not limited to, any type of disk including floppy disks, optical
disks, CD-ROMs and magnetic-optical disks, read-only memories
(ROMs), random access memories (RAMs), EPROMs, EEPROMs, magnetic or
optical cards, flash memory devices including universal serial bus
(USB) storage devices (e.g., USB key devices) or any type of media
suitable for storing electronic instructions, each of which may be
coupled to a computer system bus.
[0030] The algorithms and displays presented herein are not
inherently related to any particular computer or other apparatus.
Various general purpose systems may be used with programs in
accordance with the teachings herein or it may prove convenient to
construct more specialized apparatus to perform the required method
steps. The required structure for a variety of these systems will
be apparent from the description above. In addition, the present
invention is not described with reference to any particular
programming language. It will be appreciated that a variety of
programming languages may be used to implement the teachings of the
invention as described herein.
[0031] The present invention may be provided as a computer program
product, or software, that may include a machine-readable medium
having stored thereon instructions, which may be used to program a
computer system (or other electronic devices) to perform a process
according to the present invention. A machine-readable medium
includes any mechanism for storing or transmitting information in a
form readable by a machine (e.g., a computer). For example, a
machine-readable (e.g., computer-readable) medium includes a
machine (e.g., a computer) readable storage medium (e.g., read only
memory ("ROM"), random access memory ("RAM"), magnetic disk storage
media, optical storage media, flash memory devices, etc.), a
machine (e.g., computer) readable transmission medium
(non-propagating electrical, optical, or acoustical signals),
etc.
[0032] FIG. 1 is a block diagram illustrating an exemplary computer
network 100 in which embodiments of the present invention may
operate. Referring to FIG. 1, computer network 100 may be comprised
of at least one RFP management platform 110, a plurality of
computing devices 120A-120N associated with PBMs 120 and a
plurality of computing devices 130A-130N associated with clients
130 (or one or more representative entities authorized to act on
behalf of a client). Computing devices associated with PBMs 120 and
clients 130 may be communicatively coupled, via a network 140, to
one or more processing and storage accessible components of RFP
management platform 110. Network 140 may be a private network
(e.g., a local area network (LAN), wide area network (WAN),
intranet, etc.) or a public network (e.g., the Internet).
[0033] RFP management platform 110 may be enabled by one or more
computing modules configured to process various processes of the
present invention, as described herein. For example, RFP management
platform 110 may be comprised of a client module 112 and a PBM
module 114. In one embodiment, client module 112 may be configured
to manage all aspects of a client's interaction with RFP management
platform 110, while PBM module 114 may be configured to manage all
aspects of a PBM's interaction with RFP management platform 110. In
another embodiment, client module 112 may be primarily configured
to manage all aspects of generating a RFP for bidding by
participating PBMs, while PBM module 114 may be configured to
manage all aspects of adjudicating and scoring bids received from
participating PBMs in response to the RFP.
[0034] Client module 112 may be comprised of a plurality of
components for processing instructions to execute methods
associated with conducting an RFP process involving interactions
by, or gathering of data relating to, clients 130. Referring to
FIG. 2, client module 112 may comprise, for example, a client
manager 222, a RFP generator component 224, a data collection
component 226 and a bid presentation component 228. Client manager
222 may be configured to control all aspects of managing client
side interactions with RFP management platform 110 including, but
not limited to, enabling and controlling components 224, 226 and
228. Component 224, 226 and 228 may be configured, for example, to
generate an RFP, determine whether criteria required for
participating in the RFP are satisfied, identify and communicate
RFP parameters to select PBMs 120, retrieve existing plan data
related to clients 130, present bid information to assist in a bid
selection process and any other applicable processes or
corresponding determinations for administering a RFP on behalf of a
participating client entity.
[0035] PBM module 114 may be comprised of a plurality of components
processing instructions to execute methods associated with
conducting an RFP process involving interactions by, or gathering
of data relating to, PBMs 120. Referring to FIG. 2, PBM module 114
may comprise, for example, a PBM manager 232, a data collection
component 234, an adjudication component 236 and a scoring
component 238. PBM manager 232 may be configured to control all
aspects of managing PBM side interactions with RFP management
platform 110 including, but not limited to, enabling and
controlling components 234, 236 and 238. Component 234, 236 and 238
may be configured, for example, to manage distribution of an RFP
and related client data to participating PBMs, enable bid
preparation and submission by a PBM, adjudicate proposed bids,
score bids submitted by a PBM and any other applicable processes or
corresponding determinations for administering submission of a bid
on behalf of a participating PBM.
[0036] Those skilled in the art will appreciate that RFP management
platform 110 may be configured with more or less modules and
components to conduct the methods described herein with reference
to FIGS. 3-7. As illustrated in FIGS. 3-7, each of corresponding
methods 300, 400, 500, 600 and 700 may be performed by processing
logic that may comprise hardware (e.g., circuitry, dedicated logic,
programmable logic, microcode, etc.), software (such as
instructions run on a processing device), or a combination thereof.
In one embodiment, methods 300, 400, 500, 600 and 700 may be
performed by one or more processing components associated with
modules 112 and 114 of RFP management platform 110.
[0037] FIG. 3 is a flow diagram illustrating a method 300 for
managing an RFP between a client and participating PBMs, according
to an embodiment of the invention. Referring to FIG. 3, method 300
may be initiated upon receiving, at block 302, a request to
initiate an RFP process. For example, method 300 may be initiated
when a client participant requests a new RFP. Upon receiving the
request, the new RFP may be generated and distributed, at block
304, to potential PBM respondents. Confirmation (e.g. electronic,
oral, etc.) may be received, at block 306, from PBM participants
acknowledging receipt and participation in the RFP evaluation.
[0038] Bid scenarios may be received, at block 308, from
participating PBMs in response to the RFP. RFP management platform
110 may be configured to permit participating PBMs to execute a
plurality of bid scenarios (i.e., present varying costs, terms and
definitions) and allow for each of the bid scenarios to be
adjudicated, at block 310, prior to submitting a bid by PBMs in
response to the RFP. When method 300 determines, at block 312, that
a bid scenario has been selected to be submitted as the bid in
response to the RFP, each of the bids received from participating
PBMs may be scored, at block 314, for presentation to the client.
However, if the bid scenario is not selected at block 312, due to
missing information or error, the bid may be returned to the
participating PBM at block 308.
[0039] In one embodiment, if a determination is made, at block 316,
that additional rounds of bidding will be engaged, due to
determination of an inadequate scores for the bids received, then
method 300 may be configured to transmit, at block 318, a request
soliciting revised bids to the RFP to a subset of the participating
PBMs. The subset may be determined, for example, based on scores
associated with the original bids submitted by the participating
PBMs. Once a determination is made, at block 316, that no
additional rounds of bidding will be engaged, final bids from the
subset of participating PBMs may be presented, at block 320, to the
client for review and selection of a prevailing bid. "Prevailing
bids" may be defined as bids characterized by scores illustrative
of significantly favorable projected-cost structures, market
competitive benefits, enhanced cost savings over a projected period
of time, etc.
[0040] FIG. 4 is a flow diagram illustrating a method 400 for
generating a RFP, according to an embodiment of the invention.
Referring to FIG. 4, method 400 may be initiated upon receiving an
indication from RFP management platform 110 that a new RFP is to be
generated for a client. Information retrieval for generating the
new RFP may be initiated, at block 402, in response to the client
request for the RFP. Method 400 may receive a variety of
information, at blocks 404-410, pertaining to client's existing
prescription drug plan (e.g., prescription-claims data, formulary
data and incumbent PBM data, etc.), client conditions for PBM
participation, client preferences for bidding time frames and
scoring of bids received, distribution of the RFP to select PBMs
and any other information relevant to generating the RFP and
enabling bidding thereon. Once the RFP has been generated, at block
412, and approved for distribution, at block 414, the RFP may be
transmitted, at block 416, to PBMs selected to receive an
invitation to participate in the RFP bidding process. If the RFP is
not approved for distribution, at block 414, due to a lack of
information or error in the information, additional information may
be retrieved from client and provided to blocks 404-410 to
regenerate the RFP.
[0041] FIG. 5 is a flow diagram illustrating a method 500 for
constructing a bid in response to an RFP, according to an
embodiment of the invention. Referring to FIG. 5, method 500 may be
initiated upon determining, at block 502, that a PBM has accepted
an invitation to participate in the RFP bidding process. If the PBM
has been accepted the invitation, at block 502, the process
continues to block 508. In one embodiment, method 500 may continue
to receive acknowledgements from PBMs that wish to participate in
the RFP bidding process (even if a PBM initially declines an
invitation to participate at block 502) until bidding begins. For
example, a time period may be set for receiving acknowledgements to
participate before actual bidding is opened to PBMs. Method 500 may
determine, at block 504, whether the bidding process has started.
If not, additional PBMs may be permitted, at block 506, to
acknowledge participation in bidding on the RFP.
[0042] Information retrieval for constructing a bid for a
participating PBM may be initiated, at block 508, once bidding on
the RFP is started. Method 500 may receive various information, at
block 510 and block 512, pertaining to plan terms, definitions and
costs (e.g. rates and discount guarantees) the participating PBM is
offering or agreeing to provide. Once the required information is
submitted by a participating PBM, a proposed bid may be
constructed, at block 514, to be received and processed at RFP
management platform 110. As identified in method 300 illustrated in
FIG. 3, an adjudication process may be engaged, at block 310, for
bids received from participating PBMs. The adjudication process,
which is described in additional detail with reference to method
600 illustrated in FIG. 6, may allow the standardization of bids
received across the pool of participating PBMs.
[0043] FIG. 6 is a flow diagram illustrating a method 600 for
implementing an adjudication process, according to an embodiment of
the invention. Referring to FIG. 6, method 600 may be initiated
upon receiving, at block 602, an indication to execute an
adjudication process for a bid scenario. Pricing and definitions
associated with a corresponding plan represented by the bid
scenario may be identified, at block 604. Additionally, related
client data from a prior period (the same data provided to a
participating PBM in constructing a bid) is retrieved, at block
606, and projected forward (i.e., inflated) for a specified period
of time--e.g., three (3) years. Forward projections may be based
upon configurable parameters set separately for each of the three
(3) projection years.
[0044] For each year of a projection, an inflation percentage may
be applied to a claim set based upon division of drug claims into
brand, generic, and specialty drug classifications utilizing data
indicators provided by third party data sources (e.g., licensed
industry databases). Drug classification may be determined on a
claim by claim basis using a custom configured algorithm in order
to ensure that inflation is applied consistently across all PBM
bids, regardless of the PBM drug classification terms selected. For
each classification type (brand, generic, and specialty) and each
year of the projection, a stored percentage value may be applied,
indicating the utilization inflation percentage and price inflation
percentage. As a result, drug spend may be uniformly applied across
all PBM bids, but specific to the drug mix and claims contained in
the RFP claims data.
[0045] Thereafter, estimated plan costs for the projected client
data may be calculated, at block 608, based on the pricing and
definitions provided in the bid scenario and presented, at block
610, to the PBM for review. If the PBM is satisfied with the
estimated costs associated with the bid scenario, the bid may be
submitted as the PBM's bid to undergo a scoring process.
[0046] FIG. 7 is a flow diagram illustrating a method 700 for
implementing a scoring process, according to an embodiment of the
invention. Referring to FIG. 7, method 700 may be initiated upon
receiving, at block 702, an indication to execute a scoring process
for a submitted bid to an RFP received from a participating PBM. In
implementing the scoring process, method 700 may calculate weighted
scores associated with costs of a plan, at block 704. Weighted
scores associated with contract terms and definitions of a plan may
be calculated at block 706, or weighted scores associated with any
other category of a plan submitted in the bid by the participating
PBM may be calculated. Scores calculated for one or more categories
of the plan may then be used to determine, at block 708, a total
score for the plan. The total score for the plan may be presented
for consideration to the client originating the RFP at block
710.
[0047] In calculating a score for a particular category of the
plan, multiple factors underlying the category may be taken into
consideration. For example, in calculating a score for the terms
and definitions category of the plan, factors relating to agreement
and/or disagreement of definitions, PBM services offered, audit and
bill review, term and termination of the plan, confidentiality
elements, technical definitions of drug pricing classifications,
specific pricing discounts, performance guarantees and any other
applicable measure may be taken into consideration and assigned a
weighted score as a percentage of a total score possible for the
category. Scoring percentages and weights may be predefined via
administrative settings or be subject to client preferences.
[0048] FIG. 8 illustrates a diagrammatic representation of a
machine in the exemplary form of a computer system 800 within which
a set of instructions for causing the machine to perform any one or
more of the methodologies discussed herein, may be executed. In
alternative embodiments, the machine may be connected (e.g.,
networked) to other machines in a local area network (LAN), an
intranet, an extranet, or the Internet. The machine may operate in
the capacity of a server or a client machine in a client-server
network environment, or as a peer machine in a peer-to-peer (or
distributed) network environment. The machine may be a personal
computer (PC), a tablet PC, a set-top box (STB), a personal digital
assistant (PDA), a cellular telephone, a web appliance, a server, a
network router, switch or bridge, or any machine capable of
executing a set of instructions (sequential or otherwise) that
specify actions to be taken by that machine. Further, while only a
single machine is illustrated, the term "machine" shall also be
taken to include any collection of machines that individually or
jointly execute a set (or multiple sets) of instructions to perform
any one or more of the methodologies discussed herein.
[0049] The exemplary computer system 800 may be comprised of
components, including, a processing device 802, a main memory 804
(e.g., read-only memory (ROM), flash memory, dynamic random access
memory (DRAM) (such as synchronous DRAM (SDRAM) or Rambus DRAM
(RDRAM), etc.), a static memory 806 (e.g., flash memory, static
random access memory (SRAM), etc.), and a data storage device 818,
which communicate with each other via a bus 830.
[0050] Processing device 802 represents one or more general-purpose
processing devices such as a microprocessor, central processing
unit, or the like. More particularly, the processing device may be
a complex instruction set computing (CISC) microprocessor, reduced
instruction set computer (RISC) microprocessor, very long
instruction word (VLIW) microprocessor, or processor implementing
other instruction sets, or processors implementing a combination of
instruction sets. Processing device 802 may also be one or more
special-purpose processing devices such as an application specific
integrated circuit (ASIC), a field programmable gate array (FPGA),
a digital signal processor (DSP), network processor, or the like.
Processing device 802 is configured to execute processing logic 826
for performing the operations and steps discussed herein.
[0051] Computer system 800 may further include a network interface
device 808. Computer system 800 also may include a video display
unit 810 (e.g., a liquid crystal display (LCD) or a cathode ray
tube (CRT)), an alphanumeric input device 812 (e.g., a keyboard), a
cursor control device 814 (e.g., a mouse), and a signal generation
device 816 (e.g., a speaker).
[0052] Data storage device 818 may include a machine-readable
storage medium (or more specifically a computer-readable storage
medium) 828 having one or more sets of instructions (e.g., software
822) embodying any one or more of the methodologies of functions
described herein. For example, software 822 may store instructions
for managing a request for proposal and corresponding bids for
selection of a prescription drug plan. Software 822 may also
reside, completely or at least partially, within main memory 804
and/or within processing device 802 during execution thereof by
computer system 800; main memory 804 and processing device 802 also
constituting machine-readable storage media. Software 822 may
further be transmitted or received over a network 820 via network
interface device 808.
[0053] Machine-readable storage medium 828 may also be used to
store instructions for managing an RFP and corresponding bids for
selection of a prescription drug plan. While machine-readable
storage medium 828 is shown in an exemplary embodiment to be a
single medium, the term "machine-readable storage medium" should be
taken to include a single medium or multiple media (e.g., a
centralized or distributed database, and/or associated caches and
servers) that store the one or more sets of instructions. The term
"machine-readable storage medium" shall also be taken to include
any medium that is capable of storing or encoding a set of
instruction for execution by the machine that causes the machine to
perform any one or more of the methodologies of the present
invention. The term "machine-readable storage medium" shall
accordingly be taken to include, but not be limited to, solid-state
memories, and optical and magnetic media.
[0054] Whereas many alterations and modifications of the present
invention will no doubt become apparent to a person of ordinary
skill in the art after having read the foregoing description, it is
to be understood that any particular embodiment shown and described
by way of illustration is in no way intended to be considered a
limitation of the invention. Therefore, references to details of
various embodiments are not intended to limit the scope of the
claims, which in themselves recite only those features regarded as
the invention.
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