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Systems and methods for retaining or shifting prescription market share

机译:保持或转移处方药市场份额的系统和方法

摘要

Systems and methods are provided for retaining or shifting prescription market share. The systems and methods may include receiving a claim from a pharmacy computer, where the claim is associated with a drug requested by a customer, routing the claim to an adjudication engine for benefits processing, and receiving, from the adjudication engine, coverage information for the claim, where the coverage information indicates an amount payable by the customer. The systems and methods may further include determining whether a discount or payment is available to reduce the amount payable by the customer, where the discount or payment is associated with funding by a pharmaceutical manufacturer. If the discount or payment is available, the systems and methods may include transmitting at least a notice of availability of the discount or payment to the pharmacy computer, or automatically adjudicating the claim back to the pharmacy with the reduced amount payable by the customer.
机译:提供了用于保持或转移处方药市场份额的系统和方法。该系统和方法可以包括:从药房计算机接收索赔,其中该索赔与顾客所请求的药物相关联;将该索赔路由到判定引擎以进行收益处理;以及从该判定引擎接收针对该保险的承保范围信息。索赔,其中覆盖范围信息指示客户应付的金额。该系统和方法可以进一步包括确定折扣或付款是否可用于减少客户应付的金额,其中折扣或付款与制药商的资金相关联。如果折扣或付款可用,则该系统和方法可以包括至少将折扣或付款的可用性通知发送到药房计算机,或者自动将索赔裁定回药房,并由客户支付减少的金额。

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