SYSTEM AND METHOD TO DETERMINE PRESCRIPTION DRUG BENEFIT ELIGIBILITY FROM ELECTRONIC PRESCRIPTION DATA STREAMS
Example embodiments of a system, apparatus, and method are disclosed for determining eligibility of a prescription for a discount benefit program from one or more electronic prescription data streams. The embodiments may specify at least one eligibility check on the one or more electronic prescription data streams for confirming whether the covered entity is eligible to replenish dispensed medication under a drug discount program, and process prescription data associated with medication that has been dispensed. The example embodiments may include applying the at least one eligibility check to the electronic prescription data to generate an eligibility determination indicating whether the covered entity is eligible to replenish the dispensed medication under the drug discount program, and, in response to the eligibility determination indicating that the covered entity is eligible, automatically ordering replenishment of the medication and causing physical delivery of the ordered medication.
1 . A method for determining the eligibility of a prescription indicated within a set of electronic prescription drug data for a prescription drug discount program, the method comprising:
receiving a first stream of electronic prescription data;
determining if a prescription data set of the received first stream of electronic prescription data is eligible for a prescription drug discount program;
in response to determining that the prescription data set is eligible for the prescription drug discount program, creating an eligibility record;
receiving a second stream of electronic prescription data;
determining if the eligibility record matches the second stream of electronic prescription data;
in response to determining that the eligibility record matches the second stream of electronic prescription data, sending a confirmation message to a pharmacy server.
2 . The method of claim 1 , wherein at least one of the first stream of electronic prescription data or the second stream of electronic prescription data includes data in NCPDP SCRIPT format.
3 . The method of claim 1 , further comprising processing at least one of the first stream of electronic prescription data or the second stream of electronic prescription data into a common data specification.
4 . The method of claim 3 , wherein the common data specification includes one or more of patient information, a date for the prescription data set, a prescriber, a drug, a hospital location, and a provider file.