“Systems And Methods For Changing A Prescribed Medication For A Patient” in Patent Application Approval Process (USPTO 20230197222): Patent Application

2023 JUL 07 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- A patent application by the inventors DAVIS, Dwight (Little Rock, AR, US); FOTSCH, Edward (Sausalito, CA, US); PINSONNEAULT, Roger (Johns Creek, GA, US), filed on February 13, 2023, was made available online on June 22, 2023, according to news reporting originating from Washington, D.C., by NewsRx correspondents.

This patent application has not been assigned to a company or institution.

The following quote was obtained by the news editors from the background information supplied by the inventors: “Health costs continue to grow in the U.S. and are well documented as a formidable national challenge, with prescription drug costs among the leading sources of cost escalation. Currently, Prescribers are typically notified to renew existing prescriptions for their patients by phone call, fax or electronic systems when an existing prescription has expired, but cost information is generally not provided to the Prescriber, even if the cost of the medication has gone up dramatically and/or lower cost therapeutically equivalent medications are available. Alternative drug or fulfillment cost information is not routinely or automatically delivered to Prescribers or patients related to prescribing new medications or for evaluating the cost-effectiveness of existing medications. Prescribers cannot consider cost-efficiency when prescribing or renewing prescription, or at the point of care. Drug costs and cost savings opportunities are not currently considered for new or existing prescriptions, and as a result drug costs continue to escalate.

“For most drug categories there are numerous drug alternatives that a Prescriber might consider in treating a patient. Many Prescribers are not completely familiar with all drugs in every category in which they prescribe. And since Prescribers are given neither a list of alternatives to consider, nor the cost of alternative drugs, both clinical and economic efficiency are lacking.

“Drug costs can vary by many factors including: drug chosen, form of drug (long acting, etc.), patient’s insurance, patient’s deductible, including high deductible plans and Affordable Care Act (ACA) health plans, pharmacy and patient financial assistance programs. Drug costs are dynamic and change regularly, even between new scripts and renewal scripts. Drug costs may also vary depending on the fulfillment means used: e.g., $4 generics (Wal-Mart, Target, etc.), pharmacy discount card or mail order, etc. The pricing of a medication can be complicated.

“The optimal alternative drug for a given patient may vary substantially based upon payer (e.g., insurer, health organizations, etc.) formularies, payer preferences and provider preferences, or because new drugs are approved, or new uses of existing medications are found or approved.

“A prescription drug and the pharmacy used to fill the prescription may be selected via an e-Prescribing or electronic health record (“EHR”) application. For example, a Prescriber may select the drug to be prescribed. The preferred pharmacy (e.g., a ‘pharmacy of last fill’) may be a default field in electronic prescribing workflow. The patient’s preferred pharmacy is typically entered into the provider’s EHR or prescribing application when the patient initially registers with the provider for medical care. The prescription may be sent electronically to the patient’s chosen pharmacy.

“While Prescribers have shown an interest in knowing drug costs, alternative drugs and their costs, and related clinical messages about the prescriptions to be created or renewed, Prescribers typically do not want to spend time considering all possible therapeutic alternatives and then price-shopping for each drug for each patient. Prescribers often have more than one drug in a specific clinical category that they use to treat a specific illness; such as using any of a number of different Statins to treat high cholesterol. Prescribers in these instances could select drugs that are more cost effective for the patient when a prescription is created or renewed if alternative medications and costs were provided.

“There is a pressing need for identification and selection of therapeutic drug alternatives for existing medications, ideally at the time and point of care. In addition to addressing other issues in health care, the methods and apparatuses described herein may address this need.

“Health costs continue to grow in the U.S. and are well documented as a formidable national challenge, with prescription drug costs among the leading sources of cost escalation. For patients taking prescription drugs, these costs can be materially addressed by interactively identifying lower cost therapeutically equivalent alternative drug options in the context of a strategy that is sometimes referred to as “cost transparency” for patients and their caregivers. Patients, however, are unable to change their prescriptions without a licensed prescriber. Prescribers, typically doctors, may have limited time and information available to enable them to select lower cost medications, and may have limited experience with some medications that may be lower cost for patients. Pharmacists, population health clinicians or other providers (collectively referred to herein as simply “pharmacists”) may have the scope of knowledge, expertise and responsibility to assist in identifying lower cost drugs for patients, however, they lack robust interactive tools to request, receive, customize, prioritize and act upon lower cost drug alternatives.

“Currently, there is very limited alternative drug and alternate fulfillment cost information that is available on a routine or automated basis related to the cost-effectiveness of existing medications. Prescribers are typically notified to renew existing prescriptions for their patients by phone call, fax or electronic systems when the existing prescription has expired-but cost information or equivalent alternative drugs of lower cost are not typically provided to the prescriber, even if the cost of the medication-to the payer, employer or health plan and the patient-have gone up dramatically. In addition, prescribers often delegate renewals to clinical office staff who do not have the ability to change medications to lower cost alternatives even if presented during the renewal process. The prescriber’s primary job is to focus on patient care, not drug costs.

“Pharmacists who work with prescribers are often tasked with identifying and recommending lower cost alternative drugs for patients, but have no related interactive tools to proactively identify alternative drugs and identify savings on a patient-specific basis. These pharmacists may receive flat files that include spread sheets that a patient’s current medications. Separately, the pharmacists may have static lists of formularies relevant to groups of patients. As for selecting alternatives to existing medications, pharmacists lack an interactive system that identifies one or more potential alternatives and can map daily doses and day’s supply. Patient-specific drug costs and cost savings opportunities are not currently part of pharmacist’s workflow for existing prescriptions. For these reasons, while pharmacists attempt to reduce the costs for existing medications, their ability is limited by the lack of a robust interactive tools, and as a result, drug costs continue to escalate.

“For most drug categories, there are numerous drug alternatives that a prescriber might consider in treating a patient, although a prescriber may not have experience with all alternatives. Also, many drugs are used for more than one diagnosis, making the selection of alternatives more challenging since pharmacists and payers may not know the diagnosis for each patient. Pharmacists are familiar with all drugs and alternatives but lack patient-specific costs that include the patient’s pharmacy benefits coverage, formularies, deductibles and copays. Pharmacists are therefore unable to give prescribers a list of alternatives to consider, nor the cost of alternative drugs, so both clinical and economic efficiency are lacking. Even if pharmacists are presented alternatives, they are unable to customize these alternatives to include drugs which they prefer or exclude alternatives in general, on behalf of a prescriber and/or on a patient-specific basis. Also, they lack the ability to change potential alternative drugs based upon the history or diagnosis being treated for each patient.

“Drug costs can vary by many factors including: drug chosen, form of drug (tablet vs capsule, cream vs ointment, extended release, etc.), patient’s insurance, patient’s deductible-including high deductible plans and Affordable Care Act (ACA) health plans, pharmacy or pharmacy type (e.g. retail vs. mail) and patient financial assistance programs. Drug costs are dynamic and change all the time-even between new prescription renewal prescription orders. In addition, insured patients may find that their drug costs are lowered by using alternative means for fulfillment. For example, generics (Wal-Mart, Target, etc.), pharmacy discount card or mail order, etc. The determination of the pricing of a medication can be complicated.

“The optimal alternative drug, at the optimal cost, for a given patient may vary substantially based upon payer formularies, payer preferences, pharmacists’ preferences, prescriber preferences, patient clinical status and also medications previously taken by the patient.

“In current pharmacist workflows, the pharmacist working for a medical group or payer, is tasked with lowering the drug costs for a population of patients under the care of prescribers. The provider group may have entered into an Accountable Care Organization (“ACO”) contract with a payer or other type of contract that puts the provider group at risk for the overall pharmacy spend or otherwise rewards provider groups for lowering drug cost. Yet, aside from simple payer pharmacy claims, pharmacists lack the interactive tools to proactively identify and customize lower cost alternatives to existing medications that are patient and payer specific including diagnosis and patient-specific drug costs. Absent these tools, some pharmacists struggle to effectively address rising drug costs for the patients.”

There is additional background information. Please visit full patent to read further.”

In addition to the background information obtained for this patent application, NewsRx journalists also obtained the inventors’ summary information for this patent application: “The present invention relates to methods and apparatuses (e.g., devices, systems, etc., including software, firmware and/or hardware) that may help reduce health care costs, and particularly medication costs without compromising, and often actually improving, patient care by making care more affordable. For patients taking prescription drugs, these costs can be materially addressed by automatically identifying lower cost therapeutic equivalent alternative drug options for patients, prescribers (including providers or physicians), and or pharmacists.

“The methods and apparatuses described herein may enable a patient a prescriber, or a pharmacist to manipulate and/or generate a drug savings report (“DSR”) which may identify therapeutic alternatives for existing prescription medications. The DSR may include costs as well as potential savings that may be associated with alternative medications.

“These methods and apparatuses may increase cost-effective prescribing and thereby lower drug costs. These methods and apparatuses may provide prescribers, pharmacists, and patients more cost-effective, therapeutically equivalent alternatives for existing medications through one or more DSRs. Specifically, these methods and apparatuses may provide cost-optimized medication and pharmacy alternatives for existing prescriptions to prescribers, patients, and/or pharmacists to lower prescription drug costs for payers and patients. The cost-optimized alternative drug and pharmacy information may be created using any of the structured methods and apparatuses described herein. Any of these methods may include the creation and delivery of a structured form referred to herein as a drug savings report (“DSR”).

“The structured reporting described herein may be customized (in some cases sorted based on any number of characteristics associated with any prescribed medication) by any of the prescribers, pharmacists, or other authorized users. In some examples, elements of the structured report may be sorted based on a composite rank score. The composite rank score may be a relative score that may be associated with any particular medication. The composite rank score may indicate that the particular medication may have often been substituted in the past with a lower cost, therapeutically equivalent medication.

“In some examples, individuals from the patient care team (prescribers, pharmacists, etc.) may collaborate using the DSR to discuss and select alternative medications for the patient based on diagnosis, treatment, and other clinical data. The structured reports may show projected cost savings associated with any particular alternative medication selection.

“Any of the methods described herein may be used to generate a drug savings report that includes one or more alternatives for preexisting prescribed medications for a patient. Any of the methods may include receiving a request for to generate the patient’s drug saving report, generating a medication list of the patient’s preexisting prescribed medications, and identifying a plurality of therapeutically equivalent alternative medications corresponding to one or more of the patient’s preexisting prescribed medications, wherein the identification is based on a clinical equivalency of the medications. Any of the methods may further include determining a composite rank score for each preexisting prescribed medication based at least in part on the therapeutically equivalent alternative medications, wherein the composite rank score indicates a historic frequency of substitution of the preexisting prescribed medication with a lower cost therapeutically equivalent medication and providing remote access to users over a network to a drug savings report for a patient, wherein the drug savings report includes preexisting prescribed medications sorted by the composite rank score.

“In any of the methods described herein, the composite rank score may be based at least in part on data accessed from a payer claim database, a drug formulary database, a payer rules database, a patient drug cost database, or a combination thereof.

“In any of the methods described herein, generating a medication list of the patient’s preexisting prescribed medications may be based, at least in part, on a patient’s electronic health record.

“In any of the methods described herein to generate a drug savings report, identifying a plurality of therapeutically equivalent alternative medications may be based at least in part on prescriber preferences for prescribed medications. In any of the methods, the composite rank score may be further based on the patient’s clinical status.

“In any of the methods described herein, the drug savings report may be interactively sorted by a user. In some variations, the user may sort the drug savings report based on a cost savings (projected cost savings) per patient. In some other variations, the user may sort the drug savings report based on patient copay costs.

“In any of the methods described herein, generating the drug savings report may include determining a cost savings for a medication based on substituting a therapeutically equivalent alternative medication for a patient’s preexisting prescription.

“The drug savings report may be accessed by pharmacists, prescribers, or other authorized users of a patient’s care team. In any of the methods described herein, generating the drug savings report may also include suggesting, by a pharmacist, substitutions for therapeutically equivalent alternative medications for a patient’s preexisting prescribed medications based on the drug savings report, calculating a cost savings based on suggested substitutions, and updating the drug savings report based on the calculated cost savings. In some variations, the method may also include transmitting, through the network, the updated drug savings report to the prescriber. In some other variations, calculating the cost savings may include determining an estimated cost savings realized in one year for the suggest substitution. In still other variations, the method may include approving, by a prescriber, the suggested substitutions, and documenting the approved substitutions remotely documented on a server.

“In any of the methods described herein, generating the drug savings report may include generating the medication list of the patient’s preexisting prescribed medications based on a payer’s claim report. In some cases, the method may include determining the composite rank score of a medication during periods of low network activity.

“Described herein is a non-transitory computer-readable storage medium storing instructions that, when executed by one or more processors of a device, cause the device to receive a request for to generate a drug saving report, generate a list of a patient’s preexisting prescribed medications, identify a plurality of therapeutically equivalent alternative medications corresponding to one or more of the patient’s preexisting prescribed medications, wherein the identification is based on a clinical equivalency of the medications, determine a composite rank score for each preexisting prescribed medication based at least in part on the therapeutically equivalent alternative medications, wherein the composite rank score indicates a historic frequency of substitution of a preexisting prescribed medication with a lower cost therapeutically equivalent medication, and provide remote access to users over a network to a drug savings report for a patient, wherein the drug savings report includes preexisting prescribed medications sorted by the composite rank score.

“In some examples, a system for generating a drug saving report that includes alternatives for one or more preexisting prescribed medications for a patient may include: a data transceiver, one or more processors; and a memory storing instructions that, when executed by the one or more processors, cause the system to receive a request for to generate a drug saving report, generate a list of a patient’s preexisting prescribed medications, identify a plurality of therapeutically equivalent alternative medications corresponding to one or more of the patient’s preexisting prescribed medications, wherein the identification is based on a clinical equivalency of the medications, determine a composite rank score for each preexisting prescribed medication based at least in part on the therapeutically equivalent alternative medications, wherein the composite rank score indicates a historic frequency of substitution of a preexisting prescribed medication with a lower cost therapeutically equivalent medication, and provide remote access to users over a network to a drug savings report for a patient, wherein the drug savings report includes preexisting prescribed medications sorted by the composite rank score.”

There is additional summary information. Please visit full patent to read further.”

The claims supplied by the inventors are:

“1. A system for changing a prescribed medication for a patient, the system comprising: one or more processors; and a memory storing instructions that, when executed by the one or more processors, cause the one or more processors to: provide a user interface configured to receive a request for to alternative medications for the patient; identify one or more therapeutically equivalent alternative medications corresponding to one or more of the patient’s preexisting prescribed medications based on a clinical equivalency of the alternative and preexisting prescribed medications; build a query batch for two or more of: a current medication database, a clinical content database, a payer formulary database, a payer pharmacy claims database, a payer member eligibility database, and a provider group and NPI database, and independently schedule the two or more queries of the query batch; determine a copay amount, a patient savings and a total savings for each of the one or more therapeutically equivalent alternative medications based on the responses to the two or more queries of the query batch; determine a composite rank score for each preexisting prescribed medication based at least in part on the therapeutically equivalent alternative medications, wherein the composite rank score indicates a historic frequency of substitution of a preexisting prescribed medication with a lower cost therapeutically equivalent medication; and output, in the user interface, a list of a patient’s preexisting prescribed medications ranked by the composite rank score.

“2. The system of claim 1, wherein the instructions are further configured to cause the one or more processors to request to change the prescribed medication to an alternative medication of the one or more therapeutically equivalent alternative medications.

“3. The system of claim 1, wherein the instructions are further configured to cause the one or more processors to output, from an unpublished rebate estimation engine, an unpublished rebate amount for one or more of the therapeutically equivalent alternative medications, wherein the unpublished rebate amount is inferred from historical reply data from prior users, further wherein the total savings includes the unpublished rebate amount for the one or more therapeutically equivalent alternative medications.

“4. The system of claim 1, wherein the instructions are configured to cause the one or more processors to identify the one or more therapeutically equivalent alternative medications using a configurable alternatives engine.

“5. The system of claim 1, wherein the instructions are configured to cause the one or more processors to build the batch query using a data query and transfer engine.

“6. The system of claim 1, wherein the instructions are configured to cause the one or more processors to determine the composite rank score based at least in part on one or more of: a payer claim database, a drug formulary database, a payer rules database, a patient drug cost database, or a combination thereof.

“7. The system of claim 1, wherein the instructions are configured to cause the one or more processors to determine the composite rank score based on the patient’s clinical status.

“8. The system of claim 1, wherein the list of a patient’s preexisting prescribed medications comprises a drug savings report.

“9. The system of claim 8, wherein the instructions are further configured to cause the one or more processors to interactively sort, in response to input from the user interface, the drug savings report.

“10. The system of claim 1, wherein the instructions are further configured to cause the one or more processors to independently schedule the two or more queries of the query batch during periods of low network activity for each of the queried databases of the current medication database, clinical content database, payer formulary database, payer pharmacy claims database, and payer member eligibility database.

“11. A method for changing a prescribed medication for a patient, the method comprising: providing a user interface configured to receive a request for to alternative medications for the patient; identifying one or more therapeutically equivalent alternative medications corresponding to one or more of the patient’s preexisting prescribed medications based on a clinical equivalency of the alternative and preexisting prescribed medications; building a query batch for two or more of: a current medication database, a clinical content database, a payer formulary database, a payer pharmacy claims database, a payer member eligibility database, and a provider group and NPI database, and independently scheduling the two or more queries of the query batch; determining a copay amount, a patient savings and a total savings for each of the one or more therapeutically equivalent alternative medications based on the responses to the two or more queries of the query batch; determining a composite rank score for each preexisting prescribed medication based at least in part on the therapeutically equivalent alternative medications, wherein the composite rank score indicates a historic frequency of substitution of a preexisting prescribed medication with a lower cost therapeutically equivalent medication; and outputting, in the user interface, a list of a patient’s preexisting prescribed medications ranked by the composite rank score.

“12. The method of claim 11, further comprising requesting to change the prescribed medication to an alternative medication of the one or more therapeutically equivalent alternative medications.

“13. The method of claim 11, further comprising outputting, from an unpublished rebate estimation engine, an unpublished rebate amount for one or more of the therapeutically equivalent alternative medications, wherein the unpublished rebate amount is inferred from historical reply data from prior users, further wherein the total savings includes the unpublished rebate amount for the one or more therapeutically equivalent alternative medications.

“14. The method of claim 11, wherein identifying the one or more therapeutically equivalent alternative medications comprises using a configurable alternatives engine.

“15. The method of claim 11, further comprising building the batch query using a data query and transfer engine.

“16. The method of claim 11, further comprising determining the composite rank score based at least in part on one or more of: a payer claim database, a drug formulary database, a payer rules database, a patient drug cost database, or a combination thereof.

“17. The method of claim 11, further comprising determining the composite rank score based on the patient’s clinical status.

“18. The method of claim 11, wherein the list of a patient’s preexisting prescribed medications comprises a drug savings report.

“19. The method of claim 18, further comprising interactively sorting, in response to input from the user interface, the drug savings report.

“20. The method of claim 18, further comprising independently scheduling the two or more queries of the query batch during periods of low network activity for each of the queried databases of the current medication database, clinical content database, payer formulary database, payer pharmacy claims database, and payer member eligibility database.

“21. A system for changing a prescribed medication for a patient, the system comprising: one or more processors; and a memory storing instructions that, when executed by the one or more processors, cause the one or more processors to: provide a user interface configured to receive a request for to alternative medications for the patient; identify one or more therapeutically equivalent alternative medications corresponding to one or more of the patient’s preexisting prescribed medications based on a clinical equivalency of the alternative and preexisting prescribed medications; output, from an unpublished rebate estimation engine, an unpublished rebate amount for one or more of the therapeutically equivalent alternative medications, wherein the unpublished rebate amount is inferred from historical reply data from prior users; determine a copay amount, a patient savings and a total savings for each of the one or more therapeutically equivalent alternative medications, wherein the total savings includes the unpublished rebate amount for the one or more therapeutically equivalent alternative medications; and output, in the user interface, a list of the patient’s preexisting prescribed medications including the copay amount, a patient savings and a total savings.

“22. The system of claim 21, wherein the instructions are further configured to cause the one or more processors to sort the list of the patient’s preexisting prescribed medications using a composite rank score for each preexisting prescribed medication that is based at least in part on the therapeutically equivalent alternative medications, wherein the composite rank score indicates a historic frequency of substitution of a preexisting prescribed medication with a lower cost therapeutically equivalent medication.

“23. The system of claim 21, wherein the instructions are further configured to cause the one or more processors to sort, based on user input from the user interface, the list of the patient’s preexisting prescribed medications.

“24. The system of claim 21, wherein the unpublished rebate estimation engine is configured to infer the unpublished rebate amount by aggregating estimated approval scores for prior alternative medications for the patient from users of the system.

“25. The system of claim 21, wherein the unpublished rebate estimation engine is configured to iteratively update the unpublished rebate amounts for alternative medications based on user feedback.”

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

URL and more information on this patent application, see: DAVIS, Dwight; FOTSCH, Edward; PINSONNEAULT, Roger. Systems And Methods For Changing A Prescribed Medication For A Patient. U.S. Patent Application Number 20230197222, filed February 13, 2023 and posted June 22, 2023. Patent URL (for desktop use only): https://ppubs.uspto.gov/pubwebapp/external.html?q=(20230197222)&db=US-PGPUB&type=ids

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