Researchers Submit Patent Application, “System And Method For Providing Drug And Medical Pricing Information”, for Approval (USPTO 20240013245): Patent Application
2024 JAN 29 (NewsRx) -- By a
No assignee for this patent application has been made.
News editors obtained the following quote from the background information supplied by the inventors: “Conventional methods for gathering and reporting prices relating to medical products or services are based on conventional aggregating and reporting methods. For example, conventional pharmaceutical pricing aggregators operate by obtaining drug pricing information from one or more pharmacy benefit managers (“PBM”), which is then simply passed on to users looking for a lowest offered “cash” price. For example, a conventional system may obtain, calculate, and/or estimate drug prices that are available under contracts or agreements between PBMs’ various pharmacies, which is information typically not available to average consumers.
“In response to a request for a price of a specific drug, conventional systems will display relevant “cash” prices paid directly by the user for each pharmacy chain and/or display prices found in a particular geographic area. The users can compare prices for a particular drug and determine which pharmacy they prefer to purchase the drug from.
“Conventional drug pricing methods concentrate on a lowest direct “cash” price, however, the cheapest direct price of a prescription may not equate to the lowest out-of-pocket expense for a user. Conventional systems fail to take many factors and variables, such as insurance coverage and available copay discounts, into account that affect a final amount of “cash” a user pays out-of-pocket at the register. For example, a conventional drug pricing method may find a cheapest price for a prescription but a higher price at another pharmacy may be a better deal for a user based on the user’s insurance, co-pays, reimbursement sources, and other variables. Without this additional information and an analysis of that information, a user may mistakenly end up purchasing a prescription for a price believing they are receiving the best deal available to him or her, when the purchased prescription is actually costing them more than if purchased using alternative methods.
“This same problem also exists for pricing related to medical services provided by doctors, dentists, veterinarians, and other providers wherein pricing and reimbursement plans are commonly withheld from the general public, similar to PBMs.
“Therefore, a need exists for a system and method for determining a lowest purchase method and/or combination of purchase methods for purchasing one or more medicines, medical products or medical services wherein a lowest out-of-pocket expense to a user is determined based on various pricing variable and reimbursement variables.”
As a supplement to the background information on this patent application, NewsRx correspondents also obtained the inventors’ summary information for this patent application: “The primary object of the present invention is to provide a system and method for determining a lowest purchase method and/or combination of purchase methods for purchasing one or more medicines, medical products or medical services wherein a lowest out-of-pocket costs to a user is determined based on various pricing variable and reimbursement variables.
“The present invention fulfills the above and other objects by providing a system for determining a best purchase method wherein a combination of pricing variables and/or reimbursement variables are examined, such as cash, insurance reimbursement, purchasing a generic version vs. a name brand version, quantity of the prescription, pharmacy benefit managers’ (PBMs) pricing information, manufacturer’s copay discount programs, patient assistance programs (PAPs), medication assistance programs (MAPs), direct-to-consumer pricing, self-funded programs, income status of the patient, the 340BDrug Pricing Program of the Public Health Services Act, third-party pricing aggregators, manufacturers’ coupons, geographic location of a user/purchaser, and so forth, and to determine how each pricing variable and/or insurance reimbursement variable work together or independently to offset a price of a desired medical product or medical service for a user, such as a patient or caregiver. By accessing data through private and public pricing databases, the system and method of the present invention is capable of comparing and contrasting a plurality of variables to determine the lowest out of pocket scenario for that specific user.
“Third-party pricing aggregators may include conventional prescription discount programs and online price comparison tools, wherein user input and pricing variables are used to query third-party search engines for results to be presented to the user.
“An additional element of the present invention also compromises a reminder system for users to refill their medications. This includes the inclusion of the users’ specific medication, dose, and prescription timelines. Reminders preferably include a coupon for a pharmacy refilling the prescription confirming the purchase method providing the lowest-out-of-pocket purchase method and/or a coupon for a new pharmacy if a lower purchase method is determined at a new pharmacy prior to a date for re-filling the prescription.
“The reminder system may also be used to send or push reminder notifications reminding a user or customer to schedule an appointment or of a previously scheduled appointment at a medical provider, such as a doctor, dentist, veterinarian, and so forth.
“The system and method of the present invention may be used to aggregate and present quality ratings, reviews, complaints, and so forth to present to a user in addition to pricing information so a user may make as an informed decision as possible regarding the medical service or medical product being purchased.
“The above and other objects, features and advantages of the present invention should become even more readily apparent to those skilled in the art upon a reading of the following detailed description in conjunction with the drawings wherein there is shown and described illustrative embodiments of the invention.”
The claims supplied by the inventors are:
“1. A system for determining a lowest purchase price available to a specific user for a medication, medical service or medical product, said system comprising: a graphical user interface provided by a service provider network and connected for electronic communication through a networked communications system over the Internet; said graphical user interface being accessible via a user’s electronic device over the Internet; said service provider network being connected to at least one database for storing information, a management system for managing inquires and data, and a comparison system for comparing a plurality of third-party data obtained from third-party data providers; third-party data being selected based on a plurality of search parameters; and said third-party data being multiple pricing sources, insurance reimbursement variables and any discounts or coupons that affect a determination of a final lowest purchase price for the user.
“2. The system of claim 1 wherein: said graphical user interface provides capability for a user to enter information relating to a medication the user wishes to search.
“3. The system of claim 1 wherein: said graphical user interface provides capability for a user to enter information relating to a desired medical product the user wishes to search.
“4. The system of claim 2 wherein: said graphical user interface provides capability for a user to enter information relating to a desired medical procedure the user wishes to search.
“5. The system of claim 1 wherein: said third party data providers comprise at least one drug or medical manufacturer, at least one retail pharmacy or healthcare provider, at least one PBM or other pricing partner, and at least one health insurance provider unless user does not have prescription insurance.
“4. The system of claim 1 wherein: Determining a lowest cost available for a specific user by comparing pharmacy benefit managers (PBMs) pricing versus other pricing sources, including but not limited to direct pricing from manufacturers, direct pricing from retailers, direct pricing discount drug card vendors and other non-PBM sources to display the lowest cost per user.
“5. The system of claim 1 further compromising: Comparing and determining a lowest purchase price available to a specific user for a medication, medical service or medical product within a specific retailer, healthcare provider or other purchase channel.
“6. The system of claim 1 further compromising: comparing and determining a lowest purchase price available to a specific user for a medication, medical service or medical product within multiple retailers, healthcare provider or other purchase channels.
“9. The system of claim 1 wherein: a determination being made of a lowest cost available for a specific user by comparing pharmacy benefit managers pricing versus non-pharmacy benefit managers pricing sources.
“10. The system of claim 1 further comprising: a determination being made of a lowest purchase price available to a specific user for a medication, medical service, or medical product within a specific retailer, healthcare provider, or other purchase channel.
“11. The system of claim 1 further comprising: a determination being made of a lowest cost available to a specific user for a medication, medical service, or medical product within multiple retailers, healthcare providers, or other purchase channels.
“12. The system of claim 1 further comprising: a determination of user’s geographical location being determined using the user’s electronic device.
“13. The system of claim 12 further comprising: a determination of a plurality of healthcare providers and/or pharmacies within a specified distance from the user’s determined geographic location; and a determination of prices for a searched medication or medical product or medical service at the plurality of located retail pharmacies and/or healthcare providers offering the medical service.
“14. The system of claim 12 further comprising: a determination of a plurality of medical service provider within a specified distance from the user’s determined geographic location; and a determination of prices for a searched medical service at the plurality of located medical providers.
“15. The system of claim 13 further comprising: a determination of discount pricing being available at one or more of the is determined at the plurality of located retail pharmacies.
“16. The system of claim 14 further comprising: a determination of discount pricing being available at at least one medical service provider.
“17. The system of claim 12 further comprising: a determination of available savings programs in a specified geographic area being made.
“18. The system of claim 13 further comprising: a determination of user’s available insurance reimbursement for the searched medication being made, such as level of coverage or real time benefits check of specific user coverage.
“19. The system of claim 14 further comprising: a determination of user’s available insurance reimbursement for the searched medical service being made.
“20. The system of claim 13 further comprising: a determination of a lowest purchase method for the user being determined; and the determined lowest purchase method for the user being presented via the graphical interface.
“21. The system of claim 14 further comprising: a determination of a lowest purchase method for the user being determined; and the determined lowest purchase method for the user being presented via the graphical interface.
“22. The system of claim 1 further comprising: a lowest purchase method for the user being presented a coupon or discount applied via the graphical interface.
“23. The system of claim 1 wherein: said selected third-party data is obtained through one or more third-party aggregators.
“24. The system of claim 1 wherein: said selected third-party data comprises a cash price, a retail price, insurance reimbursement information, available payment assistance and discount programs, and direct pricing.
“25. The system of claim 23 wherein: said selected third-party data comprises a cash price, a retail price, insurance reimbursement information, available payment assistance and discount programs, and direct pricing.
“26. The system of claim 1 wherein: said selected third-party data comprises a cash price, a retail price, insurance reimbursement information, available payment assistance and discount programs, and direct pricing.
“27. A system for determining a lowest purchase price available to a specific user for a medication, medical service or medical product, said system comprising: a graphical user interface provided by a service provider network and connected for electronic communication through a networked communications system over the Internet; said graphical user interface being accessible via a user’s electronic device over the Internet; said service provider network being connected to at least one database for storing information, a management system for managing inquires and data, and a comparison system for comparing a plurality of said data; said data being selected based on a plurality of search parameters; and said data being compiled from multiple pricing sources, insurance reimbursement variables and any discounts or coupons that affect a determination of a final lowest purchase price for the user.”
For additional information on this patent application, see: Bajaj, Neil H.;
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