Universal Prescription Co-Pay Offset System and Methods for Using Same

1 . A method for submitting a claim to a plurality of incentive programs to off-set a patient's financial responsibility for a pharmaceutical prescription, comprising:

commencing the filling of a patient prescription;

submitting at least a claim for the prescription, using a pre-programmed claim submission system, to a Universal Plan comprised of a plurality of incentive programs using a single Universal BIN associated to the Universal Plan by the claim submission system;

receiving a claim response from the Universal Plan; and,

charging the patient based on information received in the claim response from the Universal Plan.

2 . A method according to claim 1 , further comprising submitting a primary payer claim.

3 . A method according to claim 2 , wherein charging is based on information received from adjudicated claims submitted to at least one of the primary payer and the Universal Plan.

4 . A method according to claim 1 , wherein the submitting is performed using only the Universal BIN and drug identification information.

5 . A method according to claim 1 , wherein receiving a claim, response incorporates the application of at least one rule.

6 . A method according to claim 5 , wherein at least one rule is a Program Rule or a Pharmacy Rule.

7 . A method according to claim 1 , further comprising creating a patient profile based on at least one filling of a prescription by the patient.

8 . A method according to claim 7 , further comprising offering at least one additional incentive to the patient based on the patient's profile.

9 . A method according to claim 7 , wherein the patient voluntarily enrolls in a program to utilize information in the patient profile.

10 . A method according to claim 7 , wherein at least some of the patient profile is encoded to enhance patient privacy.

11 . A method for organizing prescription pharmaceutical plans, comprising:

associating a plurality of individual plans with a single Universal Plan; and,

associating the Universal Plan with a single Universal BIN routed to a single PBM.

12 . A method according to claim 11 , wherein the plurality of individual plans are offered by a plurality of different payers.

13 . A method according to claim 11 , wherein a claim submitted to the Universal Plan is processed for applicability to each of the plurality of individual plans associated with the Universal Plan.

14 . A method for increasing patient compliance with a health care professional created prescription medication treatment plan, comprising:

providing a Universal Plan with a Universal BIN, wherein multiple incentive programs are associated with the Universal Plan;

filling a patient prescription at a pharmacy;

submitting a pharmaceutical benefit claim for the filled patient prescription using a pre-programmed claim submission system at the pharmacy; and,

increasing patient compliance by saving the patient money as a result of submitting the pharmaceutical benefit claim and receiving an adjudicated claim response which applies an incentive coupon to the prescription.

15 . A method according to claim 14 , wherein the incentive coupon is a prior authorization coupon.

16 . A system for processing prescription pharmaceutical claims submitted to a plurality of plans, comprising:

at least one claim submitting computer located at a pharmacy, programmed with a Universal BIN associated with a Universal Plan comprised of a plurality of incentive plans;

a PBM configured to process a Universal Plan claim by identifying at least one drug which is the subject of the claim, wherein the Universal Plan is organized at the PBM to include a plurality of incentive plans; and,

a communications network operatively connected to the at least one computer and the PBM for relaying information between them.

17 . A system according to claim 16 , wherein the at least one computer is provided with a memory for storage of at least one of a software for programming the computer, patient information and rules.

18 . A system according to claim 16 , wherein the information is comprised of a transmission of a claim from the pharmacy and a claim response to the pharmacy from the PBM.

19 . A system according to claim 16 , further comprising a pharmaceutical manufacturer in communication with at least one of the pharmacy and the PBM for the transmission of rules and patient information.

20 . A system according to claim 16 , further comprising a primary payer in communication with at least one of the pharmacy and the PBM for processing a primary payer claim alternatively, additionally or preceding a claim to the Universal Plan.