Method, apparatus, and computer program product for generating alternative evaluation messages
Inventors
Assignees
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Publication Number
US-12197972-B1
Publication Date
2025-01-14
Expiration Date
Abstract
A method, apparatus and computer program product are provided for generating a first evaluation message and an alternative evaluation messages in response to an electronic message from a requesting computer. Multiple responses, including a first evaluation message response and at least one alternative evaluation message response are returned to the requesting computer. A user can select one of the multiple responses for further forwarding to a verification system via a service provider computer. The service provider computer further facilitates verification of the selected response, such as an alternative evaluation system, via the verification system. The system enables generation of multiple pricing inquiries for alternative therapy and/or via different pricing schemas, to be imitated by a pharmacy computer upon a patient requesting a prescription refill.
Core Innovation
The invention parses an electronic message indicative of a refill request associated with a first product identifier and received from a pharmacy computer. Using the parsed information, the apparatus determines a first evaluation system associated with a prescription benefit manager or a cash pricing system, and identifies a prescriber computer associated with a prescription of the first product. The apparatus then generates and causes transmission of a first evaluation message to at least the first evaluation system.
The invention further generates and causes transmission of at least one alternative evaluation message based on either a second product identifier or an alternative evaluation system. The alternative evaluation message comprises a second product identifier and/or is transmitted to a second evaluation system associated with a different prescription benefit manager or a different cash pricing system than the first evaluation system. After receiving a first evaluation message response and the at least one alternative evaluation message response, the invention causes transmission of both evaluation responses to the pharmacy computer.
At least one of the evaluation responses includes an indicator of whether the deductible is satisfied, an indicator of progress toward satisfaction of the deductible, and a deductible reset date. These deductible indicators and the deductible reset date are provided via a user interface of the pharmacy computer. The invention then receives an indication of a selection of an alternative evaluation message response, modifies the electronic message to reflect the selected alternative evaluation message response by modifying at least one of the first product identifier to the second product identifier or the first evaluation system to the second evaluation system, and transmits the modified electronic message for approval to the prescriber computer or transmits the electronic message to the second evaluation system.
Claims Coverage
The document includes three independent claims: an apparatus claim, a method claim, and a computer program product claim. Across these independent claims, there are six inventive features centered on parsing a refill request message, generating first and alternative evaluation messages to prescription benefit manager or cash pricing systems, returning evaluation responses with deductible indicators, receiving selection, modifying the message accordingly, and routing the resulting message for prescriber approval or to a selected evaluation system.
Parsing and evaluation-system determination for a refill request
Parse an electronic message indicative of a refill request associated with a first product identifier and received from a pharmacy computer to determine a first evaluation system associated with a prescription benefit manager or a cash pricing system, and a prescriber computer associated with a prescription of the first product.
First evaluation message generation and transmission
Generate and cause transmission of a first evaluation message to at least the first evaluation system.
Alternative evaluation message generation with second product identifier or second evaluation system
Generate and cause transmission of at least one alternative evaluation message, wherein at least one of the at least one alternative evaluation message comprises at least a second product identifier, or the at least one alternative evaluation message is transmitted to a second evaluation system associated with a different prescription benefit manager or a different cash pricing system than the first evaluation system.
Transmission of evaluation responses including deductible indicators to pharmacy user interface
In response to receiving a first evaluation message response and at least one alternative evaluation message response, cause transmission of the first evaluation message response and the at least one alternative evaluation message response to the pharmacy computer, wherein at least one of the first evaluation message response or the at least one alternative evaluation message response comprises an indicator of whether the deductible is satisfied, an indicator of progress toward satisfaction of the deductible, and a deductible reset date, and wherein the indicator of whether the deductible is satisfied, the indicator of progress toward satisfaction of the deductible, and the deductible reset date are provided via a user interface of the pharmacy computer.
Selection of alternative evaluation response and modification of the electronic message
Receive an indication of a selection of an alternative evaluation message response; modify the electronic message to reflect the selected alternative evaluation message response by modifying at least one of: (a) the first product identifier to the second product identifier, or (b) the first evaluation system to the second evaluation system.
Routing modified message for prescriber approval or to second evaluation system
In an instance the first product identifier in the electronic message is modified to the second product identifier, cause transmission of the modified electronic message to the prescriber computer for approval; and in an instance the first evaluation system in the electronic message is modified to the second evaluation system, cause transmission of the electronic message to the second evaluation system.
Across the independent apparatus, method, and computer program product claims, the core claimed coverage lies in coordinating first and alternative evaluation of a refill request across a prescription benefit manager or cash pricing systems, presenting evaluation responses with deductible satisfaction, progress, and reset date information via a pharmacy user interface, and then using a pharmacist selection to modify the electronic message and route it either for prescriber approval or to the selected evaluation system.
Stated Advantages
Reducing multiple pricing inquiries/transactions and related processing/network/resource consumption while enabling pricing insight before prescriber approval.
Documented Applications
No documented applications found
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