Pharmacy benefits management method and apparatus

Abstract

A pharmacy benefits management system and method. A processor server has claim information relating to pharmacy benefits claims, and information relating to a claims processing formularly stored therein. A provider server has pharmacy benefits plan structure information stored therein. A management server has price information relating drugs in various classes and a processing module for correlating the claim information with the benefits plan structure information and the formularly information to identify drugs dispensed to patients, expenses associated with the drugs in accordance with the pharmacy benefits plan structure information, alternative drugs in the same class as the drugs and expenses associated with the alternative drugs.

1 . A method of comparing alternative drugs comprising the steps of:
 receiving, by a computing device, pharmacy benefits formulary information for individual patients;   receiving, by a computing device, pharmacy benefits plan structure information for the patients;   receiving, by a computing device, information indicating a particular class of drugs;   receiving, by a computing device, price information relating to drugs in various classes the particular class;   correlating, by a computing device, the pharmacy benefits plan structure information, the price information, and the formulary information; and   determining, by a computing device and based on said correlating step, drugs in the particular class and expenses, for the individual patients, associated with the drugs in the particular class.   
     
     
         2 . The method as recited in  claim 1 , wherein the expenses in said determining step are out of pocket expense for a member of a benefits plan corresponding to the benefits plan structure information. 
     
     
         3 . The method as recited in  claim 1 , wherein said designating step comprises determining a specific drug dispensed to a patient and designating a class for that specific drug. 
     
     
         3 . The method as recited in  claim 1 , wherein the drugs in the particular class are therapeutic alternatives. 
     
     
         4 . A method as recited in  claim 1 , wherein the benefits plan structure information and the formulary information relate to a multi-tier benefits plan. 
     
     
         5 . A method as recited in  claim 1 , wherein the expenses include copayment information and total cost information. 
     
     
         6 . The method as recited in  claim 1 , wherein the information indicating particular class of drugs is information indicating a drug dispensed to a patient. 
     
     
         7 . The method as recited in  claim 1 , wherein the information indicating particular class of drugs is information indicating a drug that has not been dispensed to a patient. 
     
     
         8 . A method of analyzing pharmacy benefits plans comprising the steps of:
 receiving, by a computing device, selection of one of plural sets of pharmacy benefits formulary information;   receiving, by a computing device, selection of one of plural sets of pharmacy benefits plan structure information;   receiving, by a computing device, a selection of at least one drug;   receiving, by a computing device, price information relating to the at least one drug;   correlating, by a computing device, the pharmacy benefits plan structure information, the price information, and the formulary information; and   determining, by a computing device and based on said correlating step, expenses associated with the at least one drug for an individual patient.   
     
     
         9 . The method as recited in  claim 8 , wherein the information relating to at least one drug is information indicating a particular class of drugs. 
     
     
         10 . A computer apparatus for comparing alternative drugs comprising:
 a processor; and   a memory operatively coupled to the processor and storing instructions which, when executed by the processor cause the processor to carry out a method comprising the steps of:
 receiving pharmacy benefits formulary information for individual patients; 
 receiving pharmacy benefits plan structure information for the patients; 
 receiving, by a computing device, information indicating a particular class of drugs; 
 receiving price information relating to drugs in the particular class; 
 correlating the pharmacy benefits plan structure information, the price information, and the formulary information; and 
 determining, based on said correlating step, drugs in the particular class and expenses, for the individual patients, associated with the drugs in the particular class. 
   
     
     
         11 . The apparatus as recited in  claim 10 , wherein the expenses in said determining step are out of pocket expense for a member of a benefits plan corresponding to the benefits plan structure information. 
     
     
         12 . The apparatus as recited in  claim 10 , wherein said designating step comprises determining a specific drug dispensed to a patient and designating a class for that specific drug. 
     
     
         13 . The apparatus as recited in  claim 10 , wherein the drugs in the particular class are therapeutic alternatives. 
     
     
         14 . The apparatus as recited in  claim 10 , wherein the benefits plan structure information and the formulary information relate to a multi-tier benefits plan. 
     
     
         15 . The apparatus as recited in  claim 10 , wherein the expenses include copayment information and total cost information. 
     
     
         16 . The apparatus as recited in  claim 10 , wherein the information indicating particular class of drugs is information indicating a drug dispensed to a patient. 
     
     
         17 . The apparatus as recited in  claim 10 , wherein the information indicating particular class of drugs is information indicating a drug that has not been dispensed to a patient. 
     
     
         18 . A computer apparatus for analyzing pharmacy benefits plans comprising:
 a processor; and   a memory operatively coupled to the processor and storing instructions which, when executed by the processor cause the processor to carry out a method comprising the steps of:
 receiving selection of one of plural sets of pharmacy benefits formulary information; 
 receiving selection of one of plural sets of pharmacy benefits plan structure information; 
 receiving a selection of at least one drug; 
 receiving price information relating to the at least one drug; 
 correlating the pharmacy benefits plan structure information, the price information, and the formulary information; and 
 determining, based on said correlating step, expenses associated with the at least one drug for an individual patient. 
   
     
     
         19 . The apparatus as recited in  claim 18 , wherein the information relating to at least one drug is information indicating a particular class of drugs.