PRESCRIPTION OUTCOME ENGINE
A prescription outcome system comprising: a prescription outcome engine server connected via a network to a pharmacy computer, the prescription outcome engine server having an engine memory, and an engine processor communicably coupled to the engine memory, and the engine processor configured to execute instructions to: receive claim from a pharmacy, the claim including a patient identifier for a patient and a pharmaceutical identifier for a pharmaceutical desired to be filled; determine if the patent is included on an enrolled patient list, if the pharmaceutical is included on a pharmaceutical allowed list, and if the patient may refill the pharmaceutical at a present time; when the patient is included on the enrolled patient list, the pharmaceutical is included on a pharmaceutical allowed list, and the patient may refill the pharmaceutical at the present time, price the claim, debit employer funds, report adjudication to an employer, report adjudication to a pharmaceutical manufacturer, report adjudication to wholesaler, and return the claim to the pharmacy; and receive an eCare plan from the pharmacy, wherein the eCare plan has patient health data; evaluate the eCare plan to determine if a guaranteed patient health outcome has been achieved; when the engine processor determines the guaranteed patient health outcome has not been achieved, the engine processor directs some or all of the employer funds to be returned to the employer.
1 . A prescription outcome system comprising:
a prescription outcome engine server connected via a network to a pharmacy computer,
the prescription outcome engine server having an engine memory, and an engine processor communicably coupled to the engine memory, and the engine processor configured to execute instructions to:
receive claim from a pharmacy, the claim including a patient identifier for a patient and a pharmaceutical identifier for a pharmaceutical desired to be filled;
determine if the patent is included on an enrolled patient list, if the pharmaceutical is included on a pharmaceutical allowed list, and if the patient may refill the pharmaceutical at a present time;
when the patient is included on the enrolled patient list, the pharmaceutical is included on a pharmaceutical allowed list, and the patient may refill the pharmaceutical at the present time,
price the claim,
debit employer funds,
report adjudication to an employer,
report adjudication to a pharmaceutical manufacturer,
report adjudication to wholesaler, and
return the claim to the pharmacy; and
receive an eCare plan from the pharmacy, wherein the eCare plan has patient health data;
evaluate the eCare plan to determine if a guaranteed patient health outcome has been achieved;
when the engine processor determines the guaranteed patient health outcome has not been achieved, the engine processor directs some or all of the employer funds to be returned to the employer.
2 . The prescription outcome system of claim 1 wherein the patent health data is acquired via medical testing devices at the pharmacy and the data is automatically incorporated into the eCare plan via a computer network, with the eCare plan being stored on the outcome engine server.
3 . The prescription outcome system of claim 1 wherein the patent health data is acquired at a patient's home via medical testing devices and the data is automatically incorporated into the eCare plan via a computer network, with the eCare plan being stored on the outcome engine server.
4 . The prescription outcome system of claim 1 wherein when the engine processor determines the guaranteed patient health outcome has been achieved, the engine processor creates outcome success reports and directs the reports to be sent, via computer networks, to an employer computer, a pharmacy computer, a wholesaler computer, and a manufacturer computer.
5 . The prescription outcome system of claim 4 , further comprising the success report to the wholesaler includes instructions to submit a bonus payment to the pharmacy.
6 . The prescription outcome system of claim 4 , further comprising the success report to the manufacturer includes instructions to submit a bonus payment to the pharmacy through the wholesaler.
7 . The prescription outcome system of claim 4 , further comprising the success report to the pharmacy includes notifications of success and a bonus payment to be paid to the pharmacy.
8 . The prescription outcome system of claim 4 , further comprising the success report to the employer notice of employee success.
9 . The prescription outcome system of claim 4 , further comprising the success report to the wholesaler includes instructions to submit a bonus payment to the pharmacy, the success report to the manufacturer includes instructions to submit a bonus payment to the pharmacy through the wholesaler, the success report to the pharmacy includes notifications of success and a bonus payment to be paid to the pharmacy, and the success report to the employer notice of employee success.
10 . The prescription outcome system of claim 1 further comprising a local switch that receives claims from the pharmacy, the local switch having a switch memory, and a switch processor communicably coupled to the switch memory, and the switch processor configured to execute instructions to:
determine if the claims are for pharmaceuticals included on the pharmaceutical allowed list, and
when the pharmaceutical is not included on the pharmaceutical allowed list, reformat the claim with a primary insurance information and send the claim to an intermediary switch.
11 . The prescription outcome system of claim 10 further comprising when the pharmaceutical is included on the pharmaceutical allowed list, the claim is transferred to the outcome engine server.
12 . The prescription outcome system of claim 1 further comprising a patient ID card that has unique patient identification information for a patient primary insurance and a separate outcome engine patient identification information.
13 . A prescription outcome system comprising:
a prescription outcome engine server connected via a network to a pharmacy computer,
the prescription outcome engine server having an engine memory, and an engine processor communicably coupled to the engine memory, and the engine processor configured to execute instructions to:
receive claim from a pharmacy, the claim including a patient identifier for a patient and a pharmaceutical identifier for a pharmaceutical desired to be filled;
determine if the patent is included on an enrolled patient list, if the pharmaceutical is included on a pharmaceutical allowed list, and if the patient may refill the pharmaceutical at a present time;
when the patient is included on the enrolled patient list, the pharmaceutical is included on a pharmaceutical allowed list, and the patient may refill the pharmaceutical at the present time,
price the claim,
debit employer funds,
report adjudication to an employer,
report adjudication to a pharmaceutical manufacturer,
report adjudication to wholesaler, and
return the claim to the pharmacy; and
receive an eCare plan from the pharmacy, wherein the eCare plan has patient health data;
evaluate the eCare plan to determine if a guaranteed patient health outcome has been achieved;
when the engine processor determines the guaranteed patient health outcome has not been achieved, direct some or all of the employer funds to be returned to the employer;
wherein at least some of the patent health data is acquired via medical testing devices at the pharmacy and the data is automatically incorporated into the eCare plan via a computer network, with the eCare plan being stored on the outcome engine server;
wherein at least some of the patent health data is acquired at a patient's home via medical testing devices and the data is automatically incorporated into the eCare plan via a computer network;
wherein when the engine processor determines the guaranteed patient health outcome has been achieved, the engine processor creates outcome success reports and directs the reports to be sent, via computer networks, to an employer computer, a pharmacy computer, a wholesaler computer, and a manufacturer computer;
wherein the success report to the wholesaler includes instructions to submit a bonus payment to the pharmacy, the success report to the manufacturer includes instructions to submit a bonus payment to the pharmacy through the wholesaler, the success report to the pharmacy includes notifications of success and a bonus payment to be paid to the pharmacy, and the success report to the employer notice of employee success;
wherein the prescription outcome system further comprises a local switch that receives claims from the pharmacy, the local switch having a memory, and a processor communicably coupled to the memory, and the processor configured to execute instructions to:
determine if the claims are for pharmaceuticals included on the pharmaceutical allowed list, and
when the pharmaceutical is not included on the pharmaceutical allowed list, reformat the claim with a primary insurance information and send the claim to an intermediary switch;
wherein when the pharmaceutical is included on the pharmaceutical allowed list, the claim is transferred from the local switch to the outcome engine server; and
wherein the prescription outcome system further comprises a patient ID card that has unique patient identification information for a patient primary insurance and a separate outcome engine patient identification information.