US 11,865,199 B2
Method for providing consumer choice and equalizing pharmacy provider availability in prescription medication dispensing plans
William J. Barre, Escondido, CA (US); Dale R. Brown, Poway, CA (US); and Frederick Howe, Rancho Sante Fe, CA (US)
Assigned to MEDIMPACT HEALTHCARE SYSTEMS, INC., San Diego, CA (US)
Filed by William J. Barre, Escondido, CA (US); Dale R. Brown, Poway, CA (US); and Frederick Howe, Rancho Sante Fe, CA (US)
Filed on Jul. 21, 2010, as Appl. No. 12/841,103.
Application 12/841,103 is a division of application No. 11/266,885, filed on Nov. 4, 2005, abandoned.
Prior Publication US 2010/0287002 A1, Nov. 11, 2010
Int. Cl. A61K 8/66 (2006.01); A61Q 19/08 (2006.01); G06Q 30/06 (2023.01); A61K 8/73 (2006.01); G16H 20/10 (2018.01); G06Q 40/08 (2012.01)
CPC A61K 8/66 (2013.01) [A61K 8/732 (2013.01); A61Q 19/08 (2013.01); G06Q 30/06 (2013.01); G06Q 40/08 (2013.01); G16H 20/10 (2018.01)] 3 Claims
OG exemplary drawing
 
1. A computer-implemented system comprising:
a computer network;
a client device communicatively coupled to the computer network, the client device configured to receive order information representative of a prescription drug, the order information including a given plan payer and a quantity of the prescription drug;
a telecommunications switch communicatively coupled to the client device via the computer network, the telecommunications switch configured to receive one or more processor control numbers (PCNs) associated with the order information and route the order information based on the one or more (PCNs), a PCN being independent of the quantity of the prescription drug and the PCN uniquely identifying the prescription drug; and
a controller communicatively coupled to the client device and the telecommunications switch via the computer network, the controller configured for:
receiving prescription information about the prescription drug, the prescription information comprising the given plan payer, a dosage, the quantity and a day value indicative of number of days supply for the prescription drug, the prescription information being processed in the computer network in which the telecommunications switch is configured to communicate with a plurality of prescription benefit manager (PBM) systems, wherein the telecommunications switch is configured to mute the one or more PCNs to at least one of a first PBM system and a second PBM system, the first PBM system and the second PBM system being configured to approve the prescription drug;
determining a single PCN for the given plan payer, in response to receiving the prescription information;
forwarding the single PCN to the telecommunications switch, the telecommunications switch configured to communicate with the first PBM system for allowing for the first PBM system to approve the prescription drug based on the single PCN, regardless of the quantity of the prescription drug;
determining a reimbursement for the order, the reimbursement being equal to the lesser of a first value calculated based on a maximum allowable cost (MAC) and a second value calculated based on an average wholesale price (AWP), wherein at least one of the MAC and the AWP is adjusted in response to a difference between a guaranteed value and a reimbursement performance for a plurality of orders over a time period; and
transmitting an authorization to a pharmacy computer system to allow filling of the prescription independent of the quantity of prescription drug indicated, eliminating the need for the pharmacy computer system to assign multiple PCNs for different number of days supply and the need to select from among a plurality of communications switches to communicate with the plurality of PBM systems.