System and method for determining the cost of a pharmaceutical
A method for calculating a subscriber pharmaceutical cost that incorporates a discount is disclosed that includes receiving the discount from at least one of a pharmaceutical manufacturer and a pharmacy, and determining a subscriber cost that includes the discount, and that reduces the cost of the pharmaceutical to the subscriber at the point of sale.
1. A method performed by an electronic data machine for calculating a pharmaceutical cost for a prescription benefit management (PBM) system, comprising:
contracting with at least one pharmaceutical manufacturer to obtain a discount basis for said pharmaceutical;
receiving said discount basis and a pharmaceutical discount from said at least one pharmaceutical manufacturer for said pharmaceutical;
the electronic data machine calculating a pharmaceutical cost using said pharmaceutical discount and said discount basis for each said pharmaceutical manufacturer;
storing said pharmaceutical cost and said discount basis and said pharmaceutical discount in a database;
contracting with at least one pharmacy to obtain a pharmacy discount basis and a pharmacy discount for said pharmaceutical;
receiving said pharmacy discount basis and a pharmacy discount from said at least one pharmacy for said pharmaceutical;
calculating a total pharmacy discount cost by using said pharmacy discount and said pharmacy discount basis for each said pharmaceutical manufacturer;
storing said total pharmacy discount cost and said pharmacy discount basis and said pharmacy discount in said database;
computing a subscriber cost utilizing said pharmaceutical cost and said total pharmacy discount cost; and
transmitting said subscriber cost to a pharmaceutical dispenser; and
adding a dispensing fee to said subscriber cost.
2. The method of claim 1 , wherein the discount is represented by a discount percentage.
3. The method of claim 2 , wherein the subscriber cost is determined by multiplying the discount percentage by the discount basis to determine a dollar discount amount.
4. The method of claim 3 , further comprising subtracting the dollar discount amount from the discount basis to determine the subscriber cost.
5. The method of claim 1 , further comprising identifying at least one of an average wholesale price and a wholesale acquisition cost.
6. The method of claim 5 , further comprising identifying the package size of a pharmaceutical.
7. The method of claim 6 , further comprising dividing the at least one average wholesale price and wholesale price cost by the package size, and generating at least one of an average wholesale acquisition cost per unit and a wholesale cost per unit.
8. The method of claim 6 , further comprising determining an ingredient cost amount, wherein the ingredient cost amount is determined by multiplying the subscriber cost by the package size.
9. The method of claim 1 , further comprising determining a co-payment.
10. The method of claim 9 , further comprising adding a dispensing fee.
11. The method of claim 10 , wherein the co-payment includes the dispensing fee.
12. The method of claim 9 , further comprising classifying a pharmaceutical by tiers to generate a classification.
13. The method of claim 12 , further comprising determining the copayment by the classification of the pharmaceutical.
14. The method of claim 9 , wherein there are five tiers.
15. The method of claim 14 , wherein a first tier includes generic brands.
16. The method of claim 14 , wherein a second tier includes primary preferred brands.
17. The method of claim 14 , wherein a third tier includes preferred brands.
18. The method of claim 14 , wherein a fourth tier includes selected brands.
19. The method of claim 14 , wherein a fifth tier includes non-covered brands.
20. The method of claim 1 , further comprising:
receiving a pharmacy discount amount from a pharmaceutical dispenser at the PBM; and
reducing the discount basis for the pharmaceutical utilizing the pharmacy discount amount.
21. The method of claim 20 , wherein pharmacy discount amounts are received from a plurality of pharmaceutical dispensers.
22. The method of claim 1 , wherein the computing is performed at the PBM.
23. The method of claim 1 , wherein the computing is performed at a pharmacy.
24. The method of claim 1 , wherein the computing is performed by an insurer.
25. The method of claim 1 , wherein the computing is performed by an employer.
26. The method of claim 1 , wherein the discount basis is an original pharmaceutical cost.
27. The method of claim 1 , wherein the discount basis is an average wholesale price.
28. The method of claim 1 , wherein the discount basis is the wholesale acquisition cost.
29. The method of claim 1 , further comprising updating the discount basis periodically.
30. A method of claim 1 , wherein the subscriber cost is computed at a pharmacy.
31. The method of claim 1 , wherein the subscriber cost is computed by the insurer.
32. The method of claim 1 , wherein the subscriber cost is computed by the employer.
33. A nontransitory computer readable medium storing a program which, when executed by a computer processor, causes the computer to perform a method comprising:
contracting with at least one pharmaceutical manufacturer to obtain a discount basis for said pharmaceutical;
receiving said discount basis and a pharmaceutical discount from said at least one pharmaceutical manufacturer for said pharmaceutical;
calculating a pharmaceutical cost using said pharmaceutical discount and said discount basis for each said pharmaceutical manufacturer;
storing said pharmaceutical cost and said discount basis and said pharmaceutical discount in a database;
contracting with at least one pharmacy to obtain a pharmacy discount basis and a pharmacy discount for said pharmaceutical;
receiving said pharmacy discount basis and a pharmacy discount from said at least one pharmacy for said pharmaceutical;
calculating a total pharmacy discount cost by using said pharmacy discount and said pharmacy discount basis for each said pharmaceutical manufacturer;
storing said total pharmacy discount cost and said pharmacy discount basis and said pharmacy discount in said database;
computing a subscriber cost utilizing said pharmaceutical cost and said total pharmacy discount cost; and
transmitting said subscriber cost to a pharmaceutical dispenser; and
adding a dispensing fee to said subscriber cost.