US 12,354,724 B2
Automated prior authorization for genetic efficacy testing with prescription dispensation
Rob Todd, Doylestown, PA (US); Jerry Wrobel, Aurora, OH (US); and John Pigott, Slyvania, OH (US)
Assigned to Xact Laboratories, LLC, Twinsburg, OH (US)
Filed by Xact Laboratories, LLC, Twinsburg, OH (US)
Filed on Oct. 13, 2021, as Appl. No. 17/500,474.
Application 17/500,474 is a continuation in part of application No. 17/179,870, filed on Feb. 19, 2021, abandoned.
Application 17/179,870 is a continuation in part of application No. 16/945,198, filed on Jul. 31, 2020, granted, now 11,398,312.
Application 16/945,198 is a continuation in part of application No. 16/848,504, filed on Apr. 14, 2020, granted, now 12,217,874.
Application 16/848,504 is a continuation in part of application No. 16/674,189, filed on Nov. 5, 2019, granted, now 11,380,424.
Application 16/674,189 is a continuation in part of application No. 16/441,597, filed on Jun. 14, 2019, granted, now 11,527,331.
Application 17/500,474 is a continuation in part of application No. 16/945,198, filed on Jul. 31, 2020, granted, now 11,398,312.
Application 17/500,474 is a continuation in part of application No. 16/848,504, filed on Apr. 14, 2020, granted, now 12,217,874.
Application 17/500,474 is a continuation in part of application No. 16/674,189, filed on Nov. 5, 2019, granted, now 11,380,424.
Application 17/500,474 is a continuation in part of application No. 16/441,597, filed on Jun. 14, 2019, granted, now 11,527,331.
Claims priority of provisional application 62/685,479, filed on Jun. 15, 2018.
Claims priority of provisional application 62/773,424, filed on Nov. 30, 2018.
Prior Publication US 2022/0036990 A1, Feb. 3, 2022
Int. Cl. G16H 20/10 (2018.01); G06Q 20/08 (2012.01); G16H 10/60 (2018.01)
CPC G16H 20/10 (2018.01) [G06Q 20/0855 (2013.01); G16H 10/60 (2018.01)] 20 Claims
OG exemplary drawing
 
1. A system for incorporating in automated, real-time pharmacogenetic (PGx) testing requests and contraindication checks prior to prescription dispensation, said system comprising:
one or more databases comprising data indicating medications for which said PGx testing is available, policy rules for one or more payors, and patient-specific PGx lesting result indications for at least some of the medications;
pharmacy systems, each associated with one or more dispensing pharmacies;
a prior authorization engine comprising software instructions stored at one or more non-transitory electronic storage devices, which when executed, configures one or more processors to:
receive coverage requests for medications for patients from the pharmacy systems, and for each of said coverage request, respectively;
query said one or more databases to retrieve policy rules for a respective one of said patients (“respect patient”) associated with a respective one of said coverage requests (“respective coverage request”);
determine if coverage is otherwise available for the respective coverage request as part of a coverage decision analysis in accordance with said retrieved policy rules for the respective patient;
query said one or more databases to retrieve information regarding whether PGx testing results are available for said respective patient;
where said query results indicate that PGx testing results are available for said respective patient;
query said one or more databases to determine if any of said medications in said respective coverage request are contraindicated in said PGx testing results for said respective patient:
wherein said query results indicate that one or more of medications in said respective covers e request are contraindicated in said PGx testing results for said respective patient, generate and transmit a first standardized, encoded message indicating coverage denial for PGx contraindication to the requesting one of the pharmacy systems;
where said query results indicate that one or more of said medications in said coverage request are not contraindicated in said PGx testing results for said patient, generate and transmit a second standardized, encoded message indicating coverage approval to a requesting one of the pharmacy systems for the respective coverage request;
were said query results indicate that PGx testing results are not available for said respective patient;
query said one or more databases to retrieve information regarding whether said PGx testing is available for said medications in said respective coverage request;
where said query results indicate that said PGx testing is available for said medications in said respective coverage request, generate and transmit a third standardized, encoded message indicating temporary coverage approval, PGx testing availability, PGx testing electronic prior authorization, and requesting dispense of a PGx kit to the requesting one of the pharmacy systems; and
where said query results indicate that said PGx testing is not available for said medications in said respective coverage request, generate the second standardized encoded message to the requesting one of the pharmacy systems;
for each of said coverage requests where said medications associated with said coverage requests are not otherwise approved for coverage, generate and transmit a fourth standardized, encoded message indicating denial of coverage for non-contraindication policy reasons to the requesting pharmacy system.