Method, apparatus, and computer program product for utilizing accumulation records to reduce network transactions
Inventors
Williams, Tate • Padgett, Karen
Assignees
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Publication Number
US-11966386-B1
Publication Date
2024-04-23
Expiration Date
Abstract
A method, apparatus and computer program product are provided for utilizing accumulation records to reduce a number of transactions occurring in a network. Aggregated quantities are calculated from at least a first quantity from a first sub-system and a second quantity from the second sub-system. Preliminary amounts may be reduced based on cap amounts less the aggregated quantity, and transmission of messages to certain sub-systems may be precluded. Accumulation records may be maintained by a service provider computer on an ongoing basis. The service provider computer forwards responses that reflect a reduced preliminary amount to a requesting computer that initiated a response.
Core Innovation
The invention uses a service provider computer, including a database and computer program code, to maintain accumulation records associated with a prescription drug identifier, a patient identifier, and a manufacturer. In response to initiating a routine process to aggregate rebate amounts or receiving a message indicating a prescription transaction, the service provider computer accesses a first sub-system and a second sub-system that are integrated with the apparatus but operate independently of each other to provide manufacturer rebate amounts.
The service provider computer retrieves first rebate amounts from the first sub-system and second rebate amounts from the second sub-system for one or more prescription transactions having occurred within a predefined time period, and generates an aggregated rebate amount by summing the first rebate amounts and the second rebate amounts. The aggregated rebate amount represents a sum of rebates credited for the patient identifier, the prescription drug identifier, and the manufacturer during the predefined time period, and is inserted into the accumulation record.
Upon receiving a prescription transaction from a pharmacy computer, the apparatus accesses the accumulation record to obtain the aggregated rebate amount, routes the prescription transaction to one of the first sub-system or the second sub-system to retrieve a preliminary rebate amount, and retrieves a cap amount set by the manufacturer representing a maximum amount to be paid per patient and per prescription drug during the predefined time period. The apparatus calculates a remaining rebate amount as the cap amount less the aggregated rebate amount and determines whether the preliminary rebate amount exceeds the remaining rebate amount; if so, it reduces the preliminary rebate amount to the aggregated rebate amount and precludes transmission of the prescription transaction to the other sub-system to prevent exceeding the cap amount.
The apparatus updates the accumulation record to reflect the reduced preliminary rebate amount and, in further configurations, causes transmission of a response message with the reduced preliminary rebate amount to the pharmacy computer and/or transmits the reduced preliminary rebate amount back to the sub-system(s) from which the preliminary rebate amount was originally received. The described system includes real-time or near real-time parsing, aggregation, updating, and response routing associated with maintaining and enforcing the manufacturer-defined cap.
Claims Coverage
The document provides three independent claims (apparatus, method, and computer program product) that share a common inventive concept: aggregating rebate amounts from two independently operating integrated sub-systems and enforcing a manufacturer-defined cap by reducing a preliminary rebate amount and precluding certain sub-system transmissions.
Dual-sub-system rebate aggregation into accumulation record
Access a first sub-system and a second sub-system that are integrated with the apparatus (or service provider computer) but operate independently of each other to provide the apparatus manufacturer rebate amounts; retrieve first rebate amounts from the first sub-system and second rebate amounts from the second sub-system for one or more prescription transactions having occurred within a predefined time period; generate an aggregated rebate amount by summing the first rebate amounts and the second rebate amounts; insert the aggregated rebate amount into an accumulation record associated with the prescription drug identifier, the patient identifier, and the manufacturer.
Preliminary rebate determination subject to cap via remaining rebate amount
Receive, from a pharmacy computer, a prescription transaction comprising the patient identifier and the prescription drug identifier; access the accumulation record to obtain the aggregated rebate amount; route the prescription transaction to one of the first sub-system or the second sub-system to retrieve a preliminary rebate amount for the prescription transaction; retrieve a cap amount set by the manufacturer representing a maximum amount to be paid per patient and per prescription drug during the predefined time period; calculate a remaining rebate amount as the cap amount less the aggregated rebate amount; determine the preliminary rebate amount exceeds the remaining rebate amount, and in response thereto, reduce the preliminary rebate amount to the aggregated rebate amount; update the accumulation record to reflect the reduced preliminary rebate amount.
Precluding further sub-system transmission to avoid exceeding cap
In response to determining the preliminary rebate amount exceeds the remaining rebate amount, preclude transmission of the prescription transaction (or preclude transmission of a message) to the other at least one of the first sub-system or the second sub-system to prevent the prescription transaction from resulting in exceeding the cap amount set by the manufacturer.
Response and/or back-transmission of reduced preliminary rebate
Cause transmission of a response message containing the reduced preliminary rebate amount to a pharmacy computer and/or transmit the reduced preliminary rebate amount back to at least one of the first sub-system or the second sub-system from which the preliminary rebate amount was received.
Real-time or near real-time determination and reduction
Determine the preliminary rebate amount exceeds the remaining rebate amount and reduce the preliminary rebate amount in real time or near real time in response to receiving the prescription transaction from the pharmacy computer (or after receiving the prescription transaction as applicable in the independent claim set).
Across the independent claims, the invention aggregates rebate amounts from two independently operating integrated sub-systems into an accumulation record, calculates a remaining rebate amount relative to a manufacturer-defined cap, reduces a preliminary rebate amount when it would exceed the remaining amount, and prevents transmission that would cause the cap to be exceeded, with configurations that transmit the reduced preliminary rebate to the pharmacy computer and/or back to the providing sub-system(s).
Stated Advantages
Prevents the prescription transaction from resulting in exceeding the cap amount set by the manufacturer.
Reduces the preliminary rebate amount to align credited rebates with the manufacturer-defined cap.
Precludes transmission to prevent cap-exceeding outcomes.
Reduces network transactions by precluding message transmission to certain sub-systems when the cap would be exceeded.
Documented Applications
Maintaining accumulation records for a patient having an associated patient identifier and a prescription drug having an associated prescription drug identifier, to aggregate rebates associated with a manufacturer during a predefined time period and to process prescription transactions received from a pharmacy computer.
Coordinating multiple integrated but independently operating sub-systems that provide manufacturer rebate amounts for prescription transactions so that manufacturer rebate caps are enforced per patient and per prescription drug during the predefined time period.
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