Methods and systems for generic opportunity scoring
View Patent ↗A computer implemented method and/or computer system determines a Generic Opportunity Score (GOS) and/or a generic drug's performance demonstrating how a generic utilization can be better identified and improved relative to the total overall generic opportunity, which can provide savings information relative to a clinically appropriate generic alternative. In some embodiments, the process and/or system determines the GOS as the proportion of generic prescriptions dispensed relative to the maximum number of prescriptions that have a generic equivalent or a clinically-appropriate generic alternative. In some embodiments, the process determines the GOS as the number of generic claims dispensed over the total number of generic claims plus the brand claims that have a generic equivalent or generic alternative. In some embodiments, the data utilized will be provided through a prescription claims database, which can be segmented into three distinct groups: Generic Code Number (GCN), Brand/Generic Code, and Channel, i.e. retail or mail.
1. A method comprising:
determining, on a processor, a number of generic prescriptions dispensed from claims data;
determining, on the processor, a number of brand name prescription drugs dispensed with a generic equivalent from the claims data, the generic equivalent of a brand name prescription drug being a drug produced after expiration of a patent on the brand name prescription drug that includes the same active ingredients as the prescription drug but is sold under a different brand name through a different manufacturer than the manufacturer of the band name prescription drug;
determining, on the processor, a number of brand name prescription drugs dispensed with a generic alternative from the claims data, the generic alternative used to treat a same condition as the brand name prescription drug but including different chemicals than those included in the brand name prescription drug;
calculating, on the processor, a ratio of the number of generic prescriptions dispensed to a combination of the number of generic prescriptions dispensed, the number of brand name prescription drugs with a generic equivalent, and the number of brand name prescription drugs dispensed with a generic alternative;
determining, on the processor, a total dollar spent on prescription claims for generic prescriptions dispensed and brand prescriptions dispensed included among the claims data;
applying, on the processor, the calculated ratio to the total dollar spent to generate a generic equivalent portion from the total dollar spent; and
determining a potential amount of savings associated with generic drug usage based on the claims data and generation of the generic equivalent portion.
2. The method of claim 1 , further comprising:
sorting the claims data into groups of generic prescriptions dispensed, brand prescription drugs with generic equivalents, and brand prescription drugs with generic alternative data into three groups of data
wherein sorting of the claims data is performed prior to determination of the number of generic prescriptions dispensed, determination of the number of brand name prescriptions dispensed with a generic equivalent, and determination of the number of brand name prescriptions dispensed with a generic alternative.
3. The method of claim 1 , further comprising:
generating price differential data for each brand name prescription among the claims data that could have been fulfilled by at least one of a generic equivalent or clinically-appropriate generic alternative.
4. The method of claim 1 , further comprising:
generating a message to a recipient of a particular brand name prescription drug regarding a particular generic equivalent to the particular brand name prescription drug.
5. The method of claim 1 , wherein the number of generic prescriptions dispensed from claims data included a number of the generic maintenance prescription drugs dispensed, the number of brand name prescription drugs dispensed with a generic equivalent from the claims data include the number of brand name maintenance prescription drugs dispensed with a generic equivalent, and the number of brand name prescription drugs dispensed with a generic alternative from the claims data include the number of brand name maintenance prescription drugs dispensed with a generic alternative, and
wherein calculating the ratio includes calculating the number of generic maintenance prescription drugs dispensed to a combination of the number of generic maintenance prescription drugs dispenses, the number of brand name maintenance prescription drugs with a generic equivalent, and the number of brand name maintenance prescription drugs dispensed with a generic alternative.
6. The method of claim 1 , wherein the number of generic prescriptions dispensed from claims data included a number of the generic acute prescription drugs dispensed, the number of brand name prescription drugs dispensed with a generic equivalent from the claims data include the number of brand name acute prescription drugs dispensed with a generic equivalent, and the number of brand name prescription drugs dispensed with a generic alternative from the claims data include the number of brand name acute prescription drugs dispensed with a generic alternative, and
wherein calculating the ratio includes calculating the number of generic acute prescription drugs dispensed to a combination of the number of generic acute prescription drugs dispenses, the number of brand name acute prescription drugs with a generic equivalent, and the number of brand name acute prescription drugs dispensed with a generic alternative.
7. A non-transitory machine-readable medium comprising instructions, which when executed by one or more processors, cause the one or more processors to perform the following operations:
determine a number of generic prescriptions dispensed from claims data; determine a number of brand name prescription drugs dispensed with a generic equivalent from the claims data, the generic equivalent of a brand name prescription drug being a drug produced after expiration of a patent on the brand name prescription drug that includes the same active ingredients as the prescription drug but is sold under a different brand name through a different manufacturer than the manufacturer of the band name prescription drug;
determine a number of brand name prescription drugs dispensed with a generic alternative from the claims data, the generic alternative used to treat a same condition as the brand name prescription drug but including different chemicals than those included in the brand name prescription drug;
calculate a ratio of the number of generic prescriptions dispensed to a combination of the number of generic prescriptions dispensed, the number of brand name prescription drugs with a generic equivalent, and the number of brand name prescription drugs dispensed with a generic alternative;
determine a total dollar spent on prescription claims for generic prescriptions dispensed and brand prescriptions dispensed included among the claims data;
apply the calculated ratio to the total dollar spent to generate a generic equivalent portion from the total dollar spent; and
determine a potential amount of savings associated with generic drug usage based on the claims data and generation of the generic equivalent portion.