COORDINATION OF BENEFITS SYSTEM AND METHOD FOR PAYING PARTICIPATING PHARMACY A PORTION OF A PATIENT'S COPAYMENTS FOR PRESCRIBED MEDICATIONS

摘要

The copayment amount due the participating pharmacy a member patient for preparing a compounded or other specialty medication as determined by the Pharmacy Benefit Manager is ascertained by the system. The system calculates the portion of copayment amount that the system is obligated to pay the pharmacy based upon the products used in the preparation of the prescribed medicine obtained by the pharmacy from an affiliated supplier. The system advises the pharmacy of the copayment amount to be paid by the patient. The system then pays the pharmacy the calculated portion of the copayment amount that the system is obligated to pay. The system collects, aggregates and stores data about the transactions between patients and participating pharmacies. It may enhance the stored data by connecting with third party data bases. The data is customized and sold to the participating pharmacies or outside entities.

主权项

1. A method of providing coordination of benefits for an insured member patient seeking to purchase a prescribed compounded or specialty medication from a participating pharmacy in communication with a Pharmacy Benefit Manager responsible for determining the amount of the purchase price of the medication covered by the pharmacy benefits of the member patient and the copayment amount due from the member patient, which participating pharmacy obtains one or more products used in preparing the prescribed medication for the member patient from an affiliated pharmaceutical supplier, the method being implemented by a system including a computer capable of collecting and storing data relating to the transaction between the member patient and the participating pharmacy, the method comprising the steps of:
(a) ascertaining the copayment amount due from the member patient as determined by the Pharmacy Benefit Manager; (b) calculating the portion of copayment amount that the system is obligated to pay the pharmacy based upon the products used in the preparation of the prescribed medicine obtained by the pharmacy from the affiliated supplier; (c) advising the pharmacy of the copayment amount to be paid by the member patient; and (d) paying the pharmacy the calculated portion of the copayment amount that the system is obligated to pay the pharmacy.