Researchers Submit Patent Application, “System And Method For Facilitating And Managing Patient Payments And Discounts Related To Healthcare Marketplace Transactions”, for Approval (USPTO 20210295369): Kalderos Inc.

2021 OCT 11 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- From Washington, D.C., NewsRx journalists report that a patent application by the inventors Docken, Jeremy (Chicago, IL, US); Litow, Micah (Chicag, IL, US), filed on September 12, 2020, was made available online on September 23, 2021.

The patent’s assignee is Kalderos Inc. (Chicago, Illinois, United States).

News editors obtained the following quote from the background information supplied by the inventors: “The domestic pharmaceutical supply chain provides for certain systems and methods for distributing pharmaceutical products from a drug manufacturer to a pharmacy or physician office, which are ultimately dispensed to a consumer or patient, and for obtaining payment from the patient and a patient’s health insurance plan back through the supply chain to the pharmacy or physician office, drug manufacturer, and various other intermediaries.

“Typically in the conventional pharmaceutical supply chain, pharmaceutical products are sold by the drug manufacturer to a wholesaler, which then fulfills replenishment orders at pharmacies or physician offices. As prescriptions are filled, a pharmacy benefits manager working with the pharmacy and a particular patient’s health insurance plan attempts to coordinate pricing and reimbursement rates to be sure the pharmacy is ultimately fairly compensated for filling the prescription, the health insurance plan receives discounts or rebates from the drug manufacturer, and the patient pays the appropriate out-of-pocket cost.

“The conventional systems and methods involved in the domestic pharmaceutical supply chain for effectuating discounts focus on one or a select handful of preferred pharmaceutical discount programs and do not take into account the entire discount program universe, including the coordination of discounts stemming from or mandated by numerous programs, including but not limited to, federal programs such as the Medicare Prescription Drug Benefit (often referred to as “Medicare Part D” or simply “Part D” coverage), state programs such as the Medicaid Drug Rebate Program (“Medicaid”), commercial managed care formulary discounts, and/or the so-called “340B” drug discounts stemming from Section 340B of the Public Health Service Act of 1992.

“None of the conventional systems and methods involved in the domestic pharmaceutical supply chain provide for a system-level solution that provides for the effective coordination of all drug discount programs and/or provides for a point-of-sale discount between the drug manufacturer and the pharmacy, physician’s office, and/or patient. Consequently, double-discounting and overpayment/underpayment for drugs is a typical inefficiency in the conventional domestic pharmaceutical supply chain.

“Moreover, drug manufacturers (“Discount Payers”) seeking to deliver discounts directly to patients through the form of a so-called “co-pay coupon” often are blocked by Pharmaceutical Benefits Managers (“PBM”), which have increasingly started using co-pay accumulators to deny patients the ability to use co-pay coupon benefits towards satisfying the patient’s deductible.

“A Jun. 19, 2020 proposed rule for the Centers for Medicare & Medicaid Services, Department of Health and Human Services (“HHS”), 42 CFR Parts 433, 438, 447, and 456, if approved, would fundamentally change how drug manufacturers design and operationalize patient discounts, such as co-pay coupon programs, by requiring that patients receive the entire benefit of manufacturer-provided co-pay support.

“As a result of the ineffectiveness of conventional systems and methods of patient discounts and co-pay coupon programs, there presently is no way for a drug manufacturer or other entity to directly fund, or provide discounts to, a patient for the provision of pharmaceuticals, medical devices, medical diagnostics, or medical procedures. There presently is no system or method in the marketplace that is immediately compliant with the HHS proposed rule.”

As a supplement to the background information on this patent application, NewsRx correspondents also obtained the inventors’ summary information for this patent application: “According to one non-limiting aspect of the present disclosure, an example embodiment of a method is disclosed for effectuating a payment to a patient relating to the cost of pharmaceutical product between a discount payer or discount stakeholder, having a computing system including a processor, a memory, and an internet connection, and a patient. The method includes the steps of providing a discount manager, the discount manager having a computing system including a processor, a memory, and an internet connection, the discount manager facilitating the relationship between the discount payer and the patient; the discount payer providing a payment to the patient for acquisition of the pharmaceutical product; and the patient receiving the payment, the payment received in the form of cash to the patient or as a credit to the discount manager for future use by the patient.

“According to another non-limiting aspect of the present disclosure, an example embodiment of a system is disclosed for effectuating a payment to a patient relating to the cost of pharmaceutical product between a discount payer, having a computing system including a processor, a memory, and an internet connection, and a patient. The system includes a discount manager for facilitating payment between the discount payer and the patient, the discount manager having a computing system including a processor, a memory, and an interne connection, the discount manager having a relationship with the discount payer and a relationship with the patient; a patient-facing app provided by the discount manager, the app downloadable to and executable by a smart phone device accessible to the patient, the app being interconnected with a cloud-based network having a database storage for storing an account relating to the patient and for storing any healthcare insurance information relating to the patient; a rules matrix maintained by the discount manager and interconnected with the app, the rules matrix containing benefit information relating to any healthcare insurance of the patient; a virtual wallet residing within the app, the virtual wallet being configured to receive and hold payment or credit relating to said pharmaceutical product from the discount payer and accessible to the patient; wherein the discount manager facilitates payment from the discount payer to the patient via the virtual wallet based on applicable benefit rules contained within the rules matrix.

“Additional features and advantages are described herein, and will be apparent from the following Detailed Description and the figures.

“A skilled artisan will appreciate the foregoing details, as well as others, upon considering the following Detailed Description of certain non-limiting embodiments of the system and method for facilitating and managing patient payments and/or discounts according to the present disclosure. One of ordinary skill also may comprehend certain of such additional details upon using the systems and methods described herein.”

The claims supplied by the inventors are:

“1. A method for effectuating a payment to a patient relating to the cost of pharmaceutical product between a discount payer, having a computing system including a processor, a memory, and an internet connection, and a patient, the method comprising the steps of: providing a discount manager, said discount manager having a computing system including a processor, a memory, and an internet connection, said discount manager facilitating said relationship between said discount payer and said patient; said discount payer providing a payment to said patient for acquisition of the pharmaceutical product; and said patient receiving said payment, said payment received in the form of cash to the patient or as a credit to the discount manager for future use by the patient.

“2. The method of claim 1 wherein said discount payer is a covered entity under Rule 304B.

“3. The method of claim 2 wherein said discount payer provides a portion of a discount received under Rule 304B to the patient.

“4. The method of claim 1 wherein said discount payer is a charitable organization desiring to provide payment to said patient.

“5. The method of claim 1 wherein said discount payer is a private fundraiser desiring to provide payment to said patient.

“6. A method for determining eligibility of a patient for receiving a payment from a discount payer relating to the cost of a pharmaceutical product, the discount payer having a computing system including a processor, a memory, and an internet connection, the method comprising the steps of: providing a discount manager, said discount manager having a computing system including a processor, a memory, and an internet connection, said discount manager facilitating said relationship between said discount payer and said patient; said discount manager identifying whether the patient has any healthcare insurance; said discount manager evaluating whether the patient is eligible for reimbursement or credit relating to the pharmaceutical product under any pharmaceutical reimbursement or discount program; said discount manager selecting said pharmaceutical reimbursement or discount program that provides the maximum benefit to the patient; said discount payer providing a payment to said patient for acquisition of the pharmaceutical product; and said patient receiving said payment, said payment received in the form of cash to the patient or as a credit to the discount manager for future use by the patient.

“7. The method of claim 6 wherein said discount payer is a covered entity under Rule 304B.

“8. The method of claim 7 wherein said discount payer provides a portion of a discount received under Rule 304B to the patient.

“9. The method of claim 6 wherein said discount payer is a charitable organization desiring to provide payment to said patient.

“10. The method of claim 6 wherein said discount payer is a private fundraiser desiring to provide payment to said patient.

“11. The method of claim 6 further comprising the step of said discount manager selecting said pharmaceutical reimbursement or discount program that ensures compliance with tax laws.

“12. The method of claim 11 wherein said discount payer is a covered entity under Rule 304B.

“13. The method of claim 12 wherein said discount payer provides a portion of a discount received under Rule 304B to the patient.

“14. The method of claim 11 wherein said discount payer is a charitable organization desiring to provide payment to said patient.

“15. The method of claim 11 wherein said discount payer is a private fundraiser desiring to provide payment to said patient.

“16. A system for determining eligibility of a patient for receiving a payment from a discount payer relating to the cost of a pharmaceutical product, the discount payer having a computing system including a processor, a memory, and an internet connection, the system comprising: a discount manager having a processor, a memory, and an internet connection, said discount manager being further interconnected with each of said discount payer and discount recipient, the discount manager memory interconnected with said processor having instructions stored thereon which, when executed by said processor, causes the processor to perform operations comprising: identifying, by a data reconciliation system of said discount manager, whether said patient has any healthcare insurance; evaluating, by the data reconciliation system of said discount manager, whether the patient is eligible for reimbursement or credit relating to the pharmaceutical product under any pharmaceutical reimbursement or discount program; selecting, by the data reconciliation system of said discount manager, said pharmaceutical reimbursement or discount program that provides the maximum benefit to the patient; providing, by the data reconciliation system of said discount manager, a payment to said patient for acquisition of the pharmaceutical product.

“17. A system for effectuating a payment to a patient relating to the cost of pharmaceutical product between a discount payer, having a computing system including a processor, a memory, and an internet connection, and a patient, the system comprising: a discount manager for facilitating payment between the discount payer and the patient, the discount manager having a computing system including a processor, a memory, and an internet connection, the discount manager having a relationship with said discount payer and a relationship with said patient; a patient-facing app provided by the discount manager, the app downloadable to and executable by an electronic device accessible to said patient, the app being interconnected with a cloud-based network having a database storage for storing an account relating to said patient and for storing any healthcare insurance information relating to said patient; a rules matrix maintained by said discount manager and interconnected with said app, the rules matrix including benefit information relating to any healthcare insurance of said patient; a virtual wallet residing within the app, the virtual wallet being configured to receive and hold payment or credit relating to said pharmaceutical product from said discount payer and accessible to said patient; wherein the discount manager facilitates payment from said discount payer to said patient via said virtual wallet based on applicable benefit rules contained within said rules matrix.

“18. The system of claim 17 wherein the payment from the discount payer to the patient flows directly through the discount manager.

“19. The system of claim 17 wherein the rules matrix further includes tax rules to ensure compliance with tax law.

“20. The system of claim 17 wherein the discount manager facilitates payment from the discount payer directly to the virtual wallet of the patient.”

For additional information on this patent application, see: Docken, Jeremy; Litow, Micah. System And Method For Facilitating And Managing Patient Payments And Discounts Related To Healthcare Marketplace Transactions. Filed September 12, 2020 and posted September 23, 2021. Patent URL: https://appft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PG01&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.html&r=1&f=G&l=50&s1=%2220210295369%22.PGNR.&OS=DN/20210295369&RS=DN/20210295369

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