System and method for generating simulated prescription-drug claims

摘要

A computer system and method for generating simulated drug claims, suitable modeling and constructing drug benefit plans, the method, characterized by defining a number of lives covered and total spend amount for the simulated drug claims, wherein the method searches a drug claim database containing a plurality of de-identified, drug claims to retrieve drug claims, based on the number of lives, calculates tiers and tier ratios, determines top dispensed drugs, and creates and populates a set of simulated drug claims, until the spend amount is exhausted.

主权项

1. A computer-implemented method for instantaneously generating simulated drug claims, the method comprising:
a) providing a number of lives and spend amount for the simulated drug claims to said computer; b) said computer searching a plurality of drug claims and retrieving a subset of drug claims, based on the number of lives, wherein the drug claims contain information selected from the group consisting of drug identifier, days' supply, total amount of drug dispensed, claim cost, date of dispensation of drugs, and number of lives covered by a benefit plan, wherein the drug claims contain drug tier selected from the group consisting of retail dispense, mail-order-dispense, brand-name drug, generic drug, and specialty drug; c) said computer determining tiers and tier ratios for the subset of drug claims, wherein the tiers are selected from the group consisting of retail dispense, brand-name drug; retail dispense, generic drug; mail-order-dispense, brand-name drug; mail-order-dispense, generic drug; and specialty drug, wherein the tier ratios are selected from the group consisting of retail dispense, brand-name drugs to retail dispense, generic drugs; mail-order-dispense, brand-name drugs to mail-order-dispense, generic drugs; and dispense, specialty drugs, based on total drugs of the subset; d) said computer determining top dispensed drugs; e) said computer generating a set of simulated drug claims, based on tiers and tier ratios; and f) said computer populating the set of simulated drug claims, comprising selecting drug claims from tiers of the subset of drug claims, based on the top dispensed drugs and subtracting the drug claim price from the spent amount until the spend amount is negligible.