Prospective management process for medical benefit prescriptions

Abstract

The present invention provides an interactive, electronic, knowledge-based ordering process for specialty/biotech pharmaceuticals (medically coded drugs) which results in less waste, improved procedural efficiencies, and greater cost savings than the current ordering systems. The knowledge-base of the system is based on the health plan's clinical policies as well as the status of the patient and their entitled benefits with the health plan, and it is applied in an interactive manner through a web-enabled system which provides a real-time, prospective examination and control over requests for authorization to dispense the medically coded drugs. The system also includes a feedback loop from the specialty pharmacies to provide information on the medicines that have actually been dispensed. The system also provides to the patient, educational material and adherence reminders to affect therapeutic outcomes.

1 - 14 . (canceled) 
     
     
         15 . A method to authorize and dispense drugs, comprising:
 receiving, by an administrator computer system, user credentials from a user device associated with a user to access a web-enabled healthcare provider interface page;   authenticating, by the administrator computer system, the user credentials to provide access to the user device to the web-enabled healthcare provider interface page as an authorized healthcare provider;   accessing, by the administrator computer system, a database through the healthcare provider interface page, wherein said database comprises criteria for a plurality of drugs associated with a plurality of health plans and patient identification information associated with said health plans, said database further comprising information on a plurality of specialty pharmacies with capabilities to dispense a set of said drugs, and   wherein said healthcare provider interface page comprises a plurality of data fields;   receiving, by the administrator computer system, input data entered into a plurality of data fields on said healthcare provider interface page, wherein said input data comprises information identifying a respective patient, a selection of a drug from a listing of said drugs and a corresponding therapy criteria, and a choice of a specialty pharmacy from a listing of said specialty pharmacies;   providing, by the administrator computer system, additional information on said healthcare provider interface page where the additional information is automatically populated into said data fields from said database for said identified patient;   entering, to the administrator computer system, an authorization request on said healthcare provider interface page; and   providing, using the administrator computer system, an authorization code to be presented on the healthcare provider interface page, wherein said authorization code comprises an authentication code as a unique transaction identifier between said authorized healthcare provider and said identified patient for said selected drug and said corresponding therapy criteria.   
     
     
         16 . The method of  claim 15 , wherein said authorization code is provided within ten minutes after entering said authorization request. 
     
     
         17 . The method of  claim 15 , wherein said authorization code is provided after entering said authorization request and while said authorized healthcare provider has authenticated user rights and is accessing said healthcare provider interface page. 
     
     
         18 . The method of  claim 15 , wherein said therapy criteria is at least one of a duration period and a dosage level. 
     
     
         19 . The method of  claim 15 , wherein said automatically populated additional information is selected from the group of information consisting of: patient information, health plan information and therapy options. 
     
     
         20 . The method of  claim 15  further comprising the steps of receiving, by the authorized healthcare provider, said selected drug from said chosen specialty pharmacy;
 administering, by the authorized healthcare provider, said selected drug to said identified patient; and 
 submitting, by the authorized healthcare provider a medical claims report to said database, wherein said medical claims report comprises said authorization code with a medical confirmation that said selected drug was administered to said identified patient. 
 
     
     
         21 . The method of  claim 20 , further comprising the steps:
 accumulating, by the administrator computer system, said utilization data with a plurality of utilization data from a plurality of pharmacy dispensing reports and a plurality of medical claims reports associated with a plurality of respective authorization codes; and   reconciling rebate amounts.   
     
     
         22 . The method of  claim 15  further comprising repeating the steps of  claim 15 , administering said drug and submitting said medical claims report for a plurality of drugs and corresponding patients, and after repeating the steps, providing, by the administrator computer system based on accessing the database, a report summarizing volumes of each of said drugs administered to said patients, wherein said report contains a cross-walk key correlating said drugs with corresponding prescription drug codes. 
     
     
         23 - 25 . (canceled)