Determining Orphan Drug Eligibility for Reduced Pricing

摘要

Systems, methods, and computer-readable media are disclosed for determining whether an orphan drug is eligible for replenishment at a 340B price for the drug by evaluating orphan drug identification data, patient encounter data, and/or dispensing data with respect to one or more eligibility criteria to determine whether the orphan drug has been prescribed, dispensed, or otherwise used to treat the rare disease or condition for which it is designated or an alternate condition.

主权项

1. A computer-implemented method, comprising:
receiving, at a service provider system comprising one or more computers, orphan drug identification data, patient encounter data, and dispensing data; identifying, by the service provider system, a dispensing data record included in the dispensing data, wherein the dispensing data record corresponds to a particular drug dispensing event; determining, by the service provider system, that a first product identifier included in the dispensing data record matches a second product identifier included in an orphan drug data record included in the orphan drug identification data, wherein the product identifier identifies an orphan drug designated for treatment of a designated condition; determining, by the service provider system, that a dispensing date specified in the dispensing data record is chronologically after an effective date that the orphan drug data record was generated; retrieving, by the service provider system, a set of one or more patient encounter data records included in the patient encounter data, wherein a respective patient medical record identifier included in each patient encounter data record matches a patient medical record identifier included in the dispensing data record; determining, by the service provider system, for each patient encounter data record, that a respective patient encounter date specified in the patient encounter data record is more than a threshold period of time before a predetermined date or determining that a respective diagnosis code included in the patient encounter data record corresponds to a respective condition other than the designated condition; identifying, by the service provider system, a particular patient encounter data record that includes a diagnosis code that corresponds to a condition other than the particular condition; storing, by the service provider system, a dispensing status identifier for the dispensing data record indicating that the drug dispensing event is a dispensing of the orphan drug for a particular condition other than the designated condition; and determining, by the service provider system, whether at least one eligibility criterion is satisfied for replenishing a quantity of the orphan drug dispensed as part of the drug dispensing event at a 340B price for the orphan drug.