US 12,229,834 B1
Method, apparatus, and computer program product for partitioning prescription transaction costs in an electronic prescription transaction
Phillip Draa, Atlanta, GA (US); Jared Burdine, Dunwoody, GA (US); and John Giglio, Brookhaven, GA (US)
Assigned to MCKESSON CORPORATION, Irving, TX (US)
Filed by McKesson Corporation, Irving, TX (US)
Filed on Feb. 21, 2022, as Appl. No. 17/676,437.
Application 17/676,437 is a continuation in part of application No. 16/792,413, filed on Feb. 17, 2020, granted, now 11,610,240.
Int. Cl. G06Q 30/00 (2023.01); G06Q 30/0283 (2023.01); G06Q 40/08 (2012.01)
CPC G06Q 40/08 (2013.01) [G06Q 30/0283 (2013.01)] 15 Claims
OG exemplary drawing
 
1. An apparatus comprising at least one processor and at least one memory including computer program code, the at least one memory and the computer program code configured to, with the at least one processor, cause the apparatus to at least:
receive, at a service provider computer and from a pharmacy computer, an indication of a prescription transaction comprising a patient identifier identifying a patient and a prescription identifier identifying a drug; and
in real-time or near real-time relative to receiving the indication of the prescription transaction, and by the service provider computer:
access an alternative cost data source to determine an alternative cost of the drug available via an alternative system associated with a government-sponsored payer;
transmit a prescription claim associated with the prescription transaction to an adjudication computer identified from a plurality of adjudication computers based on insurance information provided in the prescription transaction;
receive an adjudicated prescription claim associated with the prescription transaction, the adjudicated prescription claim comprising a co-pay amount;
determine a preliminary remaining patient pay amount by applying a predefined target adherence rate to a price sensitivity model;
determine a preliminary credit amount as the co-pay amount minus the preliminary remaining patient pay amount determined by applying a predefined target adherence rate to the price sensitivity model;
determine that the preliminary credit amount would result in a payer cost that is lower than the alternative cost of the drug available via the alternative system;
in response to determining that the preliminary credit amount would result in a payer cost that is lower than the alternative cost of the drug available via the alternative system, adjust the preliminary credit amount by applying a predefined target adherence rate to the price sensitivity model, wherein the preliminary credit amount is adjusted to a credit amount that would result in a payer cost that is greater than or equal to the alternative cost;
determine a remaining patient pay amount by applying the credit amount to the preliminary credit amount determined based on at least the price sensitivity model;
in response to determining the remaining patient pay amount based at least on the price sensitivity model, reformat the adjudicated prescription claim to a format that includes the remaining patient pay amount and the credit amount, and that is readable by the pharmacy computer; and
cause transmission of the adjudicated prescription claim including the remaining patient pay amount and the credit amount to the pharmacy computer.