| 主权项 |
1. A method of processing a request pertaining to a prescription drug, the method comprising, with a suitably-programmed computer system:
receiving, after a claim requesting at least partial insurance coverage of a cost associated with the prescription drug has been submitted to an insurance benefits manager, a notification that prior authorization of the at least partial insurance coverage has been required by the insurance benefits manager; receiving information identifying the prescription drug for which a request for prior authorization of the at least partial insurance coverage under an insurance policy is to be submitted; before submitting the request for prior authorization and after receiving the notification indicating that prior authorization has been required, determining that an alternate drug is a possible substitute for the prescription drug, but is believed to not require prior authorization under the insurance policy, based on data contained in a database that is accessible to the computer system, wherein said data is generally accepted in a pharmacy industry and is not unique to an insurer affiliated with the insurance policy; without first submitting the request for prior authorization to the insurance benefits manager, transmitting content over the communication network to indicate that the alternate drug exists; determining whether the alternate drug is to be substituted for the prescription drug; and in response to receiving an indication that the alternate drug is to be substituted, suspending a process of requesting prior authorization for the prescription drug without submitting the request for prior authorization to the insurance benefits manager. |
