IP Library › Granted Patent US 12,229,833
Granted Patent B1
US 12,229,833 · App. 17/675,616 · Granted Feb 18, 2025

Method, apparatus, and computer program product for reformatting an electronic prescription transaction

Inventors: Phillip Draa (Atlanta, GA); Jared Burdine (Dunwoody, GA)
Assignee: MCKESSON CORPORATION
G06Q40/08G06Q30/0283
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Quick Facts
Patent No.
US 12,229,833
App. No.
17/675,616
Granted
Feb 18, 2025
Kind
B1
Abstract

A method, apparatus and computer program product are provided for partitioning prescription transaction costs in an electronic prescription transaction by determining a credit amount to be applied to prescription transaction, based on an alternative cash price. In circumstances which an associated prescription claim is rejected or determined to be likely rejected, such as due to a requirement for prior authorization, a patient may still be motivated to purchase a prescription via a cash transaction, particularly with the credit amount applied. The prescription transaction may be reformatted to indicate a cash transaction and include the credit amount, and may exclude benefit information. The credit amount and a reformatted prescription transaction may be transmitted to the pharmacy computer or other third party computer.

Claims (30)

1. An apparatus comprising at least one processor and at least one memory including computer program code, the at least one memory and the computer program code configured to, with the at least one processor, cause the apparatus to at least:

receive, by a service provider computer, an indication of a prescription transaction comprising a patient identifier identifying a patient, a prescription identifier identifying a drug, and benefit information associated with a first adjudication computer to which the prescription transaction is directed;

in real-time or near real-time relative to receiving the indication of the prescription transaction:

determine, by the service provider computer, that the prescription transaction is denied based on a response from a first adjudication computer or is predicted to likely be denied by invoking a prior authorization engine configured to access stored claims previously rejected based on a requirement for prior authorization;

in response to determining the prescription transaction is denied or predicted to likely be denied, execute a script configured to access a cash discount system to determine a cash price of the drug;

further in response to determining the prescription transaction is denied or predicted to likely be denied, determine, by the service provider computer, a credit amount to be applied to the cash price;

further in response to determining the prescription transaction is denied or predicted to likely be denied, and prior to adjudication of a claim associated with the prescription transaction, reformat the prescription transaction to a format associated with a second adjudication computer, different that the first adjudication computer, wherein the reformatted prescription transaction indicates a cash transaction and the credit amount, such that the reformatted prescription transaction is not subject to preauthorization requirements; and

redirect the prescription transaction and cause transmission of the reformatted prescription transaction including the indication of the cash transaction and the credit amount to at least one of a prescriber computer from which the prescription transaction was received, a pharmacy computer from which the prescription transaction was received, or the second adjudication computer.

2. The apparatus according to claim 1 , wherein the cash price of the drug is determined based on contractual pricing associated with a manufacturer.

3. The apparatus of claim 1 , wherein the at least one memory and the computer program code are configured to, with the processor, cause the apparatus to at least:

transmit the credit amount to a third party computer.

4. A method comprising:

receiving an indication of a prescription transaction comprising a patient identifier identifying a patient, a prescription identifier identifying a drug, and benefit information associated with a first adjudication computer to which the prescription transaction is directed;

in real-time or near real-time relative to receiving the indication of the prescription transaction:

determining the prescription transaction is denied or predicted to likely be denied based on a requirement for prior authorization;

in response to determining the prescription transaction is denied or predicted to likely be denied based on the requirement for the prior authorization, determining a cash price of the drug;

further in response to determining the prescription transaction is denied or predicted to likely be denied based on the requirement for the prior authorization, determining a credit amount to be applied to the cash price;

reformatting the prescription transaction to a format that indicates a cash transaction and the credit amount; and

redirecting the prescription transaction and causing transmission of the reformatted prescription transaction including the indication of the cash transaction and the credit amount to a second adjudication computer, different than the first adjudication computer.

5. The method according to claim 4 , wherein the first classification comprises an indication that a prescription benefit claim associated with the prescription transaction is at least one of denied or likely to be denied.

6. The method according to claim 4 , wherein the cash price of the drug is determined based on contractual pricing associated with a manufacturer.

7. A computer program product comprising at least one non-transitory computer-readable storage medium having computer-executable program code instructions stored therein, the computer-executable program code instructions comprising program code instructions to:

receive an indication of a prescription transaction comprising a patient identifier identifying a patient, a prescription identifier identifying a drug, and benefit information associated with a first adjudication computer to which the prescription transaction is directed;

in real-time or near real-time relative to receiving the indication of the prescription transaction:

determine the prescription transaction is denied or determined to likely be denied based on a requirement for prior authorization;

in response to determining the prescription transaction is denied or predicted to likely be denied based on the requirement for the prior authorization, determine a cash price of the drug;

further in response to determining the prescription transaction is denied or predicted to likely be denied based on the requirement for the prior authorization, determine a credit amount to be applied to the cash price;

reformat the prescription transaction to a format that indicates a cash transaction and the credit amount; and

redirect the prescription transaction and cause transmission of the reformatted prescription transaction including the indication of the cash transaction and the credit amount to a second adjudication computer, different than the first adjudication computer.

8. The computer program product according to claim 7 , wherein the cash price of the drug is determined based on contractual pricing associated with a manufacturer.

Assignments (1)
ASSIGNMENT OF ASSIGNOR'S INTEREST Recorded Feb 18, 2022
From: DRAA, PHILLIP; BURDINE, JARED
To: MCKESSON CORPORATION
Reel/Frame 059050/0500 →
Continuity (1)
Continuation In Part 16792413 · Feb 17, 2020
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