IPC분류정보
국가/구분 |
United States(US) Patent
등록
|
국제특허분류(IPC7판) |
|
출원번호 |
US-0052374
(2005-02-07)
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등록번호 |
US-8112288
(2012-02-07)
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발명자
/ 주소 |
- Paul, Les
- Foley, Amy
- Ezrow, Brian F.
- Snow, Jr., David B.
- Berger, Ella
- Epstein, Robert S.
- Bird, Beth
- Jacks, Marianne
- Anand, Tej
- Caride, Vicente L.
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출원인 / 주소 |
- Medco Health Solutions, Inc.
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대리인 / 주소 |
Stroock & Stroock & Lavan LLP
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인용정보 |
피인용 횟수 :
9 인용 특허 :
4 |
초록
▼
Systems and methods for determining options for reducing spend and/or trend for a prescription drug plan are provided. Based on an analysis of spend and/or trend for the prescription drug plan, a prescription drug spend and/or trend application may determine that an option is available to reduce spe
Systems and methods for determining options for reducing spend and/or trend for a prescription drug plan are provided. Based on an analysis of spend and/or trend for the prescription drug plan, a prescription drug spend and/or trend application may determine that an option is available to reduce spend and/or trend. For example, an option may be provided that addresses a primary component of spend and/or trend as determined by the spend and trend application. In another example, an option may be provided that addresses a deviation by the prescription drug plan from a selected performance metric. In yet another example, an option may be provided that addresses a status change for a drug in a marketplace. The spend and/or trend application may optionally project an impact of an option on the prescription drug plan (e.g., financial impact, member impact) using a related model.
대표청구항
▼
1. A method for modeling an impact of an option for reducing the spend and trend for a prescription drug plan, comprising: receiving at a prescription drug plan computer system in communication with a user computing device and a database an indication from the user computing device of a performance
1. A method for modeling an impact of an option for reducing the spend and trend for a prescription drug plan, comprising: receiving at a prescription drug plan computer system in communication with a user computing device and a database an indication from the user computing device of a performance metric for a parameter of the prescription drug plan, the prescription drug plan providing at least one of prescription drug benefits and prescription drug insurance coverage;receiving at the prescription drug plan computer system a request from the user computing device to process the spend and trend for the prescription drug plan;in response to receiving the request, retrieving by the prescription drug plan computer system data related to the prescription drug plan from the database;comparing by the prescription drug plan computer system the performance metric for the parameter to retrieved data related to the parameter;when the retrieved data deviates from the performance metric and if at least one option is available to reduce the deviation, providing by the prescription drug plan computer system an indication to the user computing device of the at least one option to reduce the deviation between the retrieved data and the performance metric, wherein the at least one option comprises at least one change to the prescription drug plan;receiving at the prescription drug plan computer system a request from the user computing device to simulate the at least one change to the prescription drug plan;applying by the prescription drug plan computer system a model to the retrieved data, wherein the model comprises a plurality of calculations to simulate the at least one change to the prescription drug plan; andproviding the user computing device with an indication of an impact on the prescription drug plan responsive to the at least one change, wherein the impact is based at least in part on the application of the model to the retrieved data;wherein spend for the prescription drug plan comprises a cost of prescription drugs under the prescription drug plan, and trend for the prescription drug plan comprises a rate of change in prescription drug spending for the prescription drug plan over time. 2. A system for modeling an impact of an option for reducing the spend and trend for a prescription drug plan, comprising: a computer system in communication with a user computing device and a database, wherein the computer system is configured to:receive an indication from the user computing device of a performance metric for a parameter of the prescription drug plan, the prescription drug plan providing at least one of prescription drug benefits and prescription drug insurance coverage;receive a request from the user computing device to process the spend and trend for the prescription drug plan;in response to receipt of the request, retrieve data related to the prescription drug plan from the database;compare the performance metric for the parameter to retrieved data related to the parameter;when the retrieved data deviates from the performance metric and if at least one option is available to reduce the deviation, provide an indication to the user computing device of the at least one option to reduce the deviation between the retrieved data and the performance metric, wherein the at least one option comprises at least one change to the prescription drug plan;receive a request from the user computing device to simulate the at least one change to the prescription drug plan;apply a model to the retrieved data, wherein the model comprises a plurality of calculations to simulate the at least one change to the prescription drug plan; andprovide the user computing device with an indication of an impact on the prescription drug plan responsive to the at least one change, wherein the impact is based at least in part on the application of the model to the retrieved data;wherein spend for the prescription drug plan comprises a cost of prescription drugs under the prescription drug plan, and trend for the prescription drug plan comprises a rate of change in prescription drug spending for the prescription drug plan over time. 3. A method for determining options for reducing the spend and trend for a prescription drug plan, comprising: receiving at a prescription drug plan computer system in communication with a user computing device and a database a request from the user computing device to process the spend and trend for the prescription drug plan, the prescription drug plan providing at least one of prescription drug benefits and prescription drug insurance coverage;in response to receiving the request, retrieving by the prescription drug plan computer system data related to the prescription drug plan from the database;receiving by the prescription drug plan computer system an indication from the user computing device of a performance metric for a parameter of the prescription drug plan;comparing by the prescription drug plan computer system the performance metric for the parameter to retrieved data related to the parameter; andwhen the retrieved data deviates from the performance metric and if at least one option is available to reduce the deviation, providing an indication to the user computing device of the at least one option to reduce the deviation between the retrieved data and the performance metric;when the at least one option is available, providing an indication of the at least one option to the user computing device, including differences between the at least one option and the prescription drug plan;receiving at the prescription drug plan computer system a request from the user computing device to simulate the at least one change to the prescription drug plan;applying by the prescription drug plan computer system a model to the retrieved data, wherein the model comprises a plurality of calculations to simulate the at least one change to the prescription drug plan; andproviding the user computing device with an indication of an impact on the prescription drug plan responsive to the at least one change, wherein the impact is based at least in part on the application of the model to the retrieved data;wherein spend for the prescription drug plan comprises a cost of prescription drugs under the prescription drug plan, and trend for the prescription drug plan comprises a rate of change in prescription drug spending for the prescription drug plan over time. 4. The method of claim 3, wherein the parameter is selected from the group consisting of member cost share, annual trend, generic substitution rate, generic dispensing rate, home delivery penetration rate, specialty medication spend, annual trend, utilization component of trend, drug mix component of trend, member cost share component of trend, discount component of trend, change in spend compared to book of business, and change of spend compared to peers. 5. The method of claim 3, wherein the components of the at least one of spend and trend relate to drug spend for a plurality of therapeutic chapters and comprise at least one of autonomic, central nervous system, cardiovascular, gastroenterology, respiratory, anti-infective, endocrine, and diabetics. 6. The method of claim 3, wherein the components of the at least one of spend and trend relate to drug spend for a plurality of diseases or conditions and comprise at least one of cardiovascular, high cholesterol, acid peptic, asthma, allergy, pain management, and diabetes. 7. The method of claim 3, wherein the components of the at least one of spend and trend relate to per-member per-month drug trend and comprise at least one of utilization, discount, inflation, drug mix, and cost share. 8. The method of claim 3, further comprising: determining whether a status change is projected for a particular drug in a marketplace; andwhen at least one option is available, providing an indication of the at least one option to the user computing device, wherein the at least one option is related to the status change for the particular drug. 9. The method of claim 8, wherein the status change for the drug is selected from the group consisting of an expiration of a patent for the drug, a new indication for the drug, a shift of the drug from prescription to over-the-counter, an introduction of the drug to the marketplace, and a withdrawal of the drug from the marketplace. 10. The method of claim 3, further comprising: determining by a user whether to accept the at least one option and thereby modify the prescription drug plan by implementing the at least one option to reduce the at least one of-spend and trend for the prescription drug plan. 11. The method of claim 3, further comprising: receiving at the prescription drug plan computer system a request from the user computing device to suppress providing an indication of a particular option to the user computing device, wherein the particular option is suppressed even if the particular option is available to reduce the at least one of spend and trend for the prescription drug plan. 12. The method of claim 3, wherein the at least one option is selected from the group consisting of a benefit management option, a member-directed initiative option, a physician-directed initiative option, a formulary type option, a plan design option, a distribution channel management option, and a specialty pharmacy option. 13. A system for determining options for reducing spend and trend for a prescription drug plan, comprising: a computer system in communication with a user computing device and a database, wherein the computer system is configured to:receive a request from the user computing device to process the spend and trend for the prescription drug plan, the prescription drug plan providing at least one of prescription drug benefits and prescription drug insurance coverage;in response to receipt of the request, retrieve data related to the prescription drug plan from a database;receive an indication from the user computing device of a performance metric for a parameter of the prescription drug plan;compare the performance metric for the parameter to retrieved data related to the parameter; andif the retrieved data deviates from the performance metric and if at least one option is available to reduce the deviation, provide an indication to the user computing device of the at least one option to reduce the deviation between the retrieved data and the performance metric;if the at least one option is available, provide an indication of the at least one option to the user computing device, including differences between the at least one option and the prescription drug plan;receive a request from the user computing device to simulate the at least one change to the prescription drug plan;apply a model to the retrieved data, wherein the model comprises a plurality of calculations to simulate the at least one change to the prescription drug plan; andprovide the user computing device with an indication of an impact on the prescription drug plan responsive to the at least one change, wherein the impact is based at least in part on the application of the model to the retrieved data;wherein spend for the prescription drug plan comprises a cost of prescription drugs under the prescription drug plan, and trend for the prescription drug plan comprises a rate of change in prescription drug spending for the prescription drug plan over time. 14. The system of claim 13, wherein the parameter is selected from the group consisting of member cost share, annual trend, generic substitution rate, generic dispensing rate, home delivery penetration rate, specialty medication spend, annual trend, utilization component of trend, drug mix component of trend, member cost share component of trend, discount component of trend, change in spend compared to book of business, and change of spend compared to peers. 15. The system of claim 13, wherein the computer system is further configured to: determine components of the at least one of-spend and trend having a significant impact on the at least one of-spend and trend; andif at least one option is available, provide the user computing device with an indication of the at least one option, wherein the at least one option is related to at least one of the components having a significant impact on the at least one of-spend and trend. 16. The system of claim 15, wherein the components of the at least one of spend and trend relate to drug spend for a plurality of therapeutic chapters and comprise at least one of autonomic, central nervous system, cardiovascular, gastroenterology, respiratory, anti-infective, endocrine, and diabetics. 17. The system of claim 15, wherein the components of the at least one of spend and trend relate to drug spend for a plurality of diseases or conditions and comprise at least one of cardiovascular, high cholesterol, acid peptic, asthma, allergy, pain management, and diabetes. 18. The system of claim 15, wherein the components of the at least one of spend and trend relate to per-member per-month drug trend and comprise at least one of utilization, discount, inflation, drug mix, and cost share. 19. The system of claim 13, wherein the computer system is further configured to: determine whether a status change is projected for a particular drug in a marketplace; andif at least one option is available, provide an indication of the at least one option to the user computing device, wherein the at least one option is related to the status change for the particular drug. 20. The system of claim 19, wherein the status change for the drug is selected from the group consisting of an expiration of a patent for the drug, a new indication for the drug, a shift of the drug from prescription to over-the-counter, an introduction of the drug to the marketplace, and a withdrawal of the drug from the marketplace. 21. The system of claim 13, wherein the computer system is further configured to: receive an indication from a user via the user computing device whether to accept the at least one option and thereby modify the prescription drug plan by implementing the at least one option to reduce the at least one of-spend and trend for the prescription drug plan. 22. The system of claim 13, wherein the computer system is further configured to: receive a request from the user computing device to suppress providing an indication of a particular option to the user computing device, and wherein the computer system is configured to suppress the particular option even if the particular option is available to reduce the at least one of-spend and trend for the prescription drug plan. 23. The system of claim 13, wherein the at least one option is selected from the group consisting of a benefit management option, a member-directed initiative option, a physician-directed initiative option, a formulary type option, a plan design option, a distribution channel management option, and a specialty pharmacy option.
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