Drug alternative recommendation engine for real-time prescription benefit requests
A method includes receiving a prescription benefit request and identifying one or more covered alternative drugs. The method also includes identifying one or more additional alternative drugs based on at least one of the requested drug and determining whether the one or more additional alternative drugs includes at least one covered additional alternative drug. The method also includes determining, for each of the at least one covered additional alternative drug and the one or more covered alternative drugs, an alternative drug value. The method also includes identifying the at least one covered additional alternative drug and the one or more covered alternative drugs having a lowest alternative drug value and generating a request response indicating at least the alternative drug of the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value.
1. A system for identifying one or more alternative drugs responsive to a prescription benefits request, the system comprising:
a processor in communication with a memory including instructions that, when executed by the processor, cause the processor to:
receive a prescription benefit request, the prescription benefit request indicating at least a requested drug and a patient identifier;
identify, in a first database, one or more covered alternative drugs based on the requested drug and a drug coverage plan associated with the patient identifier;
identify, in a second database, one or more additional alternative drugs based on at least one of the requested drug and at least one covered alternative drug of the one or more covered alternative drugs;
determine, based on the covered drug plan associated with the patient identifier, whether the one or more additional alternative drugs includes at least one covered additional alternative drug;
in response to a determination that the one or more additional alternative drugs includes at least one covered additional alternative drug, determine, for each of the at least one covered additional alternative drug and the one or more covered alternative drugs, an alternative drug value;
identify the at least one covered additional alternative drug and the one or more covered alternative drugs having a lowest alternative drug value;
rank the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value based on number of times each of the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value has been filled for an associated prescription;
generate a request response indicating at least the alternative drug of the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value ordered according to the rank; and
communicate an order associated with a prescription request to fill the alternative drug to an order processing device associated with a high-volume pharmacy; and
a pharmacy fulfillment device that:
receives, from the order processing device, instructions to fulfill the order;
identifies a puck having dimensions corresponding to a prescription container of the order;
controls at least one robotic arm to position the puck on a pallet;
controls a loading device to load the prescription container into the puck; and
controls at least one dispensing device to fulfill the order.
2. The system of claim 1 , wherein the request response further indicates the alternative drug value associated with the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value.
3. The system of claim 1 , wherein the instructions further cause the processor to determine a dosage and frequency of the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value based on a dosage and frequency of the requested drug indicated by the prescription benefit request.
4. The system of claim 3 , wherein the request response further indicates the dosage and frequency of the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value.
5. The system of claim 1 , wherein the instructions further cause the processor to:
retrieve prior prescription benefit requests having request dates within a first predetermined period; and
identify, for each request of the prior prescription benefit requests, alternative drugs filled within a second predetermined period of respective request dates associated with each request of the prior prescription benefit requests.
6. The system of claim 5 , wherein the instructions further cause the processor to,
for each alternative drug filled within the second predetermined period of respective request dates associated with each request of the prior prescription benefit requests that includes a standard therapeutic class corresponding to a standard therapeutic class of a requested drug of a corresponding prior prescription benefit request:
retrieve filled claim information associated with the corresponding prior prescription benefit requests, wherein the filled claim information indicates the number of times the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value has been filled.
7. The system of claim 6 , wherein the instructions further cause the processor to:
assign a therapeutic alternative flag to an alternative drug in response to a generic code number of the alternative drug matching a generic code number of a corresponding requested drug of a respective prior prescription benefit request; and
store, in the second database, at least each alternative drug that includes a standard therapeutic class corresponding to a standard therapeutic class of a requested drug of a corresponding prior prescription benefit request.
8. A method for identifying one or more alternative drugs responsive to a prescription benefits request, the method comprising:
receiving a prescription benefit request, the prescription benefit request indicating at least a requested drug and a patient identifier;
identifying, in a first database, one or more covered alternative drugs based on the requested drug and a drug coverage plan associated with the patient identifier;
identifying, in a second database, one or more additional alternative drugs based on at least one of the requested drug and at least one covered alternative drug of the one or more covered alternative drugs;
determining, based on the covered drug plan associated with the patient identifier, whether the one or more additional alternative drugs includes at least one covered additional alternative drug;
in response to a determination that the one or more additional alternative drugs includes at least one covered additional alternative drug, determining, for each of the at least one covered additional alternative drug and the one or more covered alternative drugs, an alternative drug value;
identifying the at least one covered additional alternative drug and the one or more covered alternative drugs having a lowest alternative drug value;
rank the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value based on number of times each of the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value has been filled for an associated prescription;
generating a request response indicating at least the alternative drug of the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value ordered according to the rank;
communicating an order associated with a prescription request to fill the alternative drug to an order processing device associated with a high-volume pharmacy;
receiving, at a pharmacy fulfillment device from the order processing device, instructions to fulfill the order;
identifying, by the pharmacy fulfillment device, a puck having dimensions corresponding to a prescription container of the order;
controlling, by the pharmacy fulfilment device, at least one robotic arm to position the puck on a pallet;
controlling, by the pharmacy fulfillment device, a loading device to load the prescription container into the puck; and
controlling, by the pharmacy fulfilment device, at least one dispensing device to fulfill the order.
9. The method of claim 8 , wherein the request response further indicates the alternative drug value associated with the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value.
10. The method of claim 8 , further comprising determining a dosage and frequency of the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value based on a dosage and frequency of the requested drug indicated by the prescription benefit request.
11. The method of claim 10 , wherein the request response further indicates the dosage and frequency of the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value.
12. The method of claim 8 , further comprising:
retrieving prior prescription benefit requests having request dates within a first predetermined period; and
identifying, for each request of the prior prescription benefit requests, alternative drugs filled within a second predetermined period of respective request dates associated with each request of the prior prescription benefit requests.
13. The method of claim 12 , further comprising, for each alternative drug filled within the second predetermined period of respective request dates associated with each request of the prior prescription benefit requests that includes a standard therapeutic class corresponding to a standard therapeutic class of a requested drug of a corresponding prior prescription benefit request:
retrieving filled claim information associated with the corresponding prior prescription benefit requests the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value; and.
14. The method of claim 13 , further comprising:
assigning a therapeutic alternative flag to an alternative drug in response to a generic code number of the alternative drug matching a generic code number of a corresponding requested drug of a respective prior prescription benefit request; and
storing, in the second database, at least each alternative drug that includes a standard therapeutic class corresponding to a standard therapeutic class of a requested drug of a corresponding prior prescription benefit request.
15. A system for identifying one or more alternative drugs responsive to a prescription benefits request, the system comprising:
a computing device configured to:
receive a prescription benefit request, the prescription benefit request indicating at least a requested drug and a patient identifier;
identify, in a first database, one or more covered alternative drugs based on the requested drug and a drug coverage plan associated with the patient identifier;
identify, in a second database, one or more additional alternative drugs based on at least one of the requested drug and at least one covered alternative drug of the one or more covered alternative drugs;
determine, based on the covered drug plan associated with the patient identifier, whether the one or more additional alternative drugs includes at least one covered additional alternative drug;
in response to a determination that the one or more additional alternative drugs includes at least one covered additional alternative drug, determine, for each of the at least one covered additional alternative drug and the one or more covered alternative drugs, an alternative drug value;
identify the at least one covered additional alternative drug and the one or more covered alternative drugs having a lowest alternative drug value;
determine a dosage and frequency of the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value based on a dosage and frequency of the requested drug indicated by the prescription benefit request;
rank the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value based on number of times each of the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value has been filled for an associated prescription;
generate a request response indicating at least the alternative drug of the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value, the alternative drug value associated with the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value, and the dosage and frequency of the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value, wherein the request response is ordered according to the rank; and
communicate an order associated with a prescription request to fill the alternative drug to an order processing device associated with a high-volume pharmacy; and
a pharmacy fulfillment device that:
receives, from the order processing device, instructions to fulfill the order;
identifies a puck having dimensions corresponding to a prescription container of the order;
controls at least one robotic arm to position the puck on a pallet;
controls a loading device to load the prescription container into the puck; and
controls at least one dispensing device to fulfill the order.
16. The system of claim 15 , wherein the computing device is further configured to:
retrieve prior prescription benefit requests having request dates within a first predetermined period; and
identify, for each request of the prior prescription benefit requests, alternative drugs filled within a second predetermined period of respective request dates associated with each request of the prior prescription benefit requests.
17. The system of claim 16 , wherein the computing device is further configured to, for each alternative drug filled within the second predetermined period of respective request dates associated with each request of the prior prescription that includes a standard therapeutic class corresponding to a standard therapeutic class of a requested drug of a corresponding prior prescription benefit request:
retrieve filled claim information associated with the corresponding prior prescription benefit requests the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value.
18. The system of claim 17 , wherein the computing device is further configured to:
assign a therapeutic alternative flag to an alternative drug in response to a generic code number of the alternative drug matching a generic code number of a corresponding requested drug of a respective prior prescription benefit request; and
store, in the second database, at least each alternative drug that includes a standard therapeutic class corresponding to a standard therapeutic class of a requested drug of a corresponding prior prescription benefit request.