US 12,076,433 B2
Pharmaceutical benefits management
William J. Barre, San Diego, CA (US); Dale R. Brown, Poway, CA (US); and Frederick Howe, Rancho Santa Fe, CA (US)
Assigned to MEDIMPACT HEALTHCARE SYSTEMS, INC., San Diego, CA (US)
Filed by MEDIMPACT HEALTHCARE SYSTEMS, INC., San Diego, CA (US)
Filed on Mar. 18, 2022, as Appl. No. 17/698,945.
Application 12/841,103 is a division of application No. 11/266,885, filed on Nov. 4, 2005, abandoned.
Application 17/698,945 is a continuation of application No. 12/841,103, filed on Jul. 21, 2010, granted, now 11,865,199.
Prior Publication US 2022/0344021 A1, Oct. 27, 2022
Int. Cl. A61K 8/66 (2006.01); A61K 8/73 (2006.01); A61Q 19/08 (2006.01); G06Q 30/06 (2023.01); G06Q 40/08 (2012.01); G16H 20/10 (2018.01)
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)] 12 Claims
OG exemplary drawing
 
1. An electronic system for routing claims, the 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 prescribed for a patient, the order information including a given plan entity 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, the telecommunications switch being configured to route the one or more PCNs to at least one of a first pharmaceutical benefits manager (PBM) system and a second PBM system, the first PBM system and the second PBM system being configured to approve the prescription drug based on whether the patient is eligible; and
a controller with a pharmaceutical benefits manager communicatively coupled to the client device and the telecommunications switch via the computer network, the pharmaceutical benefits manager configured to approve the prescription drug and configured to determine a reimbursement, the controller configured to:
receive, from the telecommunications switch, the order information based on a single PCN and a business identification number, the business identification number configured to identify the pharmaceutical benefits manager among the first PBM system and the second PBM system;
determining, using the pharmaceutical benefits manager, the reimbursement based on the order information and whether the patient is eligible;
determining, using the pharmaceutical benefits manager, an authorization for the prescription drug with the reimbursement based on the single PCN; and
transmitting the authorization with the reimbursement to the client device for the given plan entity and the quantity, the authorization and reimbursement independent of the quantity to prevent an assignment of an additional PCN for different number of days supply associated with the quantity of the prescription drug.