Patent Issued for Parallel processing for pharmacy fulfillment (USPTO 11170394): Express Scripts Strategic Development Inc.

2021 NOV 26 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- A patent by the inventors Macinski, Christina F. (St. Charles, MO, US), filed on October 1, 2019, was published online on November 9, 2021, according to news reporting originating from Alexandria, Virginia, by NewsRx correspondents.

Patent number 11170394 is assigned to Express Scripts Strategic Development Inc. (St. Louis, Missouri, United States).

The following quote was obtained by the news editors from the background information supplied by the inventors: “Pharmacy benefit managers may generally administer prescription drug programs for clients that may, for example, sponsor drug benefit programs for members. As part of the administration of prescription drug programs for clients, pharmacy benefit managers may obtain discount pricing on various prescription drugs that may be utilized by members of drug benefit programs. Pharmacy benefit managers may obtain discount pricing on prescription drugs through various mechanisms, for example through the development of pharmacy networks including retail pharmacies providing negotiated pricing discounts, through rebates from pharmaceutical manufacturers, and through the use of mail order pharmacies that may realize economic efficiencies. As such, pharmacy benefit managers may be able to provide pharmacy benefit plans that may allow members of the pharmacy benefit plan to obtain lower prices for prescription drugs, as compared to full retail pricing for prescription drugs.”

In addition to the background information obtained for this patent, NewsRx journalists also obtained the inventors’ summary information for this patent: “Example methods and systems for managing pricing guarantees are described. In the following description, for purposes of explanation, numerous specific details are set forth in order to provide a thorough understanding of example embodiments. It will be evident, however, to one of ordinary skill in the art that embodiments of the invention may be practiced without these specific details.

“In general, a client engages a pharmacy benefit manager (PBM) to offer a drug benefit program. Examples of clients include governmental organizations (e.g., Federal government agencies, the Department of Defense, the Centers for Medicare and Medicaid Services and state government agencies), middle market companies, large national employers, health insurance companies that have carved out the drug benefit, and the like. A person who is a participant or member of a drug benefit program offered by the client may obtain prescription drugs according to pricing, pharmacy selection, rebates, discounts and the like provided by the terms of the drug benefit program.

“The client’s offered drug benefit program may be a stand-alone drug benefit operated by the PBM, or as part of a health care benefit operated by a health insurance company where the PBM services are offered directly by the health insurance company or offered indirectly by the PBM on behalf of the health insurance company.

“The client typically utilizes the services of the PBM to negotiate and obtain favorable prices for at least some prescription drugs, and/or groups of prescription drugs, that may be purchased by the members, which may assist in reducing the costs to the client for member purchase of prescription drugs. In some embodiments, the PBM may guarantee to the client that the PBM will provide the client with a certain discount on prescription drugs. The discount may be, for example, a discount with respect to a pricing metric such as average wholesale price, an average retail price, or other pricing metric for prescription drugs.

“While the PBM may guarantee a certain discount (a target discount guarantee) on prescription drugs to the client for prescription drugs purchased by members, in some instances, the PBM may not be able to obtain pricing on prescription drugs that allow the PBM to achieve the discount guaranteed to the client. In some circumstances (e.g., which may be based on negotiated contractual obligation of the PBM to the client) the PBM may be responsible for reimbursing the client for any difference between a prescription drug discount achieved by the PBM that is less than the target discount guaranteed by the PBM. Example methods and systems for managing pricing guarantees for prescription drugs may allow a PBM to determine the difference between a pricing discount that the PBM actually achieves for prescription drugs, and the target discount guaranteed to the client.”

The claims supplied by the inventors are:

“1. A pharmacy fulfillment networked parallel processing method comprising: performing a predictive modification of a prescription drug pricing schedule, by a first processor of a parallel processing system, by: accessing a target discount guarantee associated with a pharmacy benefit manager client, by the first processor over a network, the target discount guarantee being based on an average wholesale price (AWP) of a plurality of different types of prescription drugs in a first class of prescription drug and a first channel of prescription drug delivery; calculating an actual prescription drug discount using a plurality of adjudicated prescription drug claims for a first time period, by the first processor, the plurality of adjudicated prescription drug claims being associated with the pharmacy benefit manager client and in the first class of prescription drug and the first channel of prescription drug delivery during the first time period predicting at least one prescription rate change for prescription drugs included in the target discount guarantee, for an anticipated future time period, by the first processor, to generate at least one predicted prescription rate change, based on one or more of: historical adjudicated claims data, seasonal prescription rate data, anticipated new drug release data, and prescription drug patent expiration data; modifying the prescription drug pricing schedule associated with the pharmacy benefit manager client, by the first processor, based on the at least one predicted prescription rate change and a difference between the target discount guarantee and the actual prescription drug discount, to create a modified prescription drug pricing schedule; and loading the modified prescription drug pricing schedule into a second processor of the parallel processing system, by the first processor; adjudicating prescription claims using an unmodified prescription drug pricing schedule until loading of the modified prescription drug pricing schedule, by the second processor operating in parallel to the first processor, wherein the first processor and the second processor operate simultaneously and continuously; and in response to the loading, replacing the unmodified prescription drug pricing schedule with the modified prescription drug pricing schedule; and using the modified prescription drug pricing schedule to adjudicate subsequent prescription claims, by the second processor operating in parallel to the first processor.

“2. The method of claim 1, wherein accessing the target discount guarantee associated with the pharmacy benefit manager client further comprises: accessing contract data associated with the pharmacy benefit manager client; and determining the target discount guarantee based on the contract data.

“3. The method of claim 1, wherein calculating the prescription drug discount further comprises: identifying a plurality of excluded prescription drug claims among the plurality of adjudicated, prescription drug claims from the target discount guarantee; and calculating the prescription drug discount from the plurality of adjudicated, prescription drug claims that are not identified as being among the plurality of excluded prescription drug claims to obtain the calculated prescription drug discount.

“4. The method of claim 3, wherein identifying the plurality of excluded prescription drug claims further comprises accessing an exclusion profile associated with the pharmacy benefit manager client, where the exclusion profile includes identification of a type of prescription drug, a class of prescription drug, a specific prescription drug, or combinations thereof excluded from the target discount guarantee.

“5. The method of claim 4, further comprising modifying the exclusion profile associated with the pharmacy benefit manager client.

“6. The method of claim 5, further comprising accessing exclusion data associated with exclusion of a particular prescription drug from the plurality of prescription drugs based on classification of the particular prescription drug as being a single source generic prescription drug, wherein modifying the exclusion profile is based on access of the exclusion data.

“7. The method of claim 6, wherein accessing exclusion data further comprises receiving an exclusion notification of a particular prescription drug from the plurality of prescription drugs based on classification of the particular prescription drug as being a single source generic prescription drug, wherein modifying the exclusion profile is based on receipt of the exclusion notification.

“8. The method of claim 6, wherein accessing exclusion data further comprises classifying a particular prescription drug from the first plurality of adjudicated, prescription drugs as being a single source generic prescription drug, wherein modifying the exclusion profile is based on classification of the particular prescription drug.

“9. The method of claim 1, further comprising: transmitting a difference notification based on the difference between the target discount guarantee and the actual discount; and receiving an approval to modify the prescription drug pricing schedule in response to transmission of the difference notification, wherein modifying the prescription drug pricing schedule is in response to receipt of the approval.

“10. The method of claim 1, wherein modifying the prescription drug pricing schedule further comprises: identifying a plurality of excluded prescription drugs; and modifying a price on the prescription drug pricing schedule of a prescription drug of the first plurality of adjudicated, prescription drug claims, the prescription drug not being an excluded drug.

“11. The method of claim 1, further comprising transmitting the modified pricing schedule to a claims adjudication system on the second processor.

“12. The method of claim 1, wherein the prescription claim further comprises a prescription claim for a tangible prescription drug as part of a plurality of prescriptions covered in an individual pricing schedule for one of a plurality of pharmacy benefit manager clients.

“13. The method of claim 1, wherein modifying the prescription drug pricing schedule further comprises: transmitting a difference notification based on the difference between the target discount guarantee and the actual discount; displaying both the target discount guarantee and the actual discount as a subset of the prescription drug pricing schedule; and receiving an approval to modify the prescription drug pricing schedule in response to transmission of the difference notification and display of the target discount guarantee and the actual discount, wherein modifying the prescription drug pricing schedule is in response to receipt of the approval.

“14. The method of claim 13, further comprising transmitting the modified prescription drug pricing schedule to the database to store the modified prescription drug pricing schedule and to a remote device to display the modified prescription drug pricing schedule.

“15. The method of claim 14, further comprising replacing the prescription drug pricing schedule with the modified prescription drug pricing schedule.

“16. The method of claim 1, further comprising tracking a channel of delivery of prescription drugs to determine the first channel of prescription drug deli very and the second channel of prescription drug delivery.

“17. The method of claim 1, further comprising classifying the prescription drugs into classes including the first class of prescription drug and the second class of prescription drug.

“18. The method of claim 1, further comprising: accessing claims data for the first time period, by the first processor over the network, the claims data indicating a prescription drug associated with adjudicated claims for the first time period, and a number of adjudications for the prescription drug during the first time period; determining a rate of adjudication for the prescription drug, based on the number of adjudications during the first time period; determining a second rate of adjudication for the anticipated future time period, the second rate varying in a pattern over time based on at least one of the historical adjudicated claims data, the seasonal prescription rate data, the anticipated new drug release data, and the prescription drug patent expiration data; and predicting the at least one prescription rate change based on the rate of adjudication for the first time period and the second rate of adjudication for the anticipated future time period.

“19. The method of claim 1, further comprising: accessing claims data for the first time period, by the first processor over the network, the claims data indicating a prescription drug associated with adjudicated claims for the first time period, and a number of adjudications for the prescription drug during the first time period; determining a rate of adjudication for the prescription drug, based on the number of adjudications during the first time period; determining a second rate of adjudication for the anticipated future time period, the second rate being constant over time based on at least one of the historical adjudicated claims data, the anticipated new drug release data, and the prescription drug patent expiration data; and predicting the at least one prescription rate change based on the rate of adjudication for the first time period and the second rate of adjudication for the anticipated future time period.”

There are additional claims. Please visit full patent to read further.

URL and more information on this patent, see: Macinski, Christina F. Parallel processing for pharmacy fulfillment. U.S. Patent Number 11170394, filed October 1, 2019, and published online on November 9, 2021. Patent URL: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=11170394.PN.&OS=PN/11170394RS=PN/11170394

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