SYSTEMS, METHODS AND COMPUTER PROGRAM PRODUCTS FOR OBTAINING A BEST AVAILABLE REIMBURSEMENT PRICE IN A PHARMACEUTICAL PRESCRIPTION TRANSACTION

摘要

Systems, methods and computer program products enable pharmacies and otherhealthcare providers to obtain the best available reimbursement price forfilling pharmaceuticalprescriptions. The present invention provides for the tracking ofreimbursement transaction data,which is utilized to derive a best available price for pharmaceuticalprescriptions. One way ofdetermining the best available price is to compare the requested reimbursementunit value to thebest unit cost (BUC). The BUC represents the highest price paid by aninsurance carrier orgroup of insurance carriers in a similar transaction, typically qualified byprovincial location,drug and insurance carrier, and/or third party processor. The BUC values areutilized todetermine if the reimbursement amount requested should be sent back formodification, flaggedfor a warning message to be sent to the pharmacy after the request has beensubmitted to theinsurance carrier or third party processor, increased to more closelyapproximate the BUC, orsubmitted as is. The requested reimbursement amount is then modifiedaccordingly and thensent to the insurance carrier or third party processor for payment. Theresponse from theinsurance carrier or third party processor is processed for capture of certaindata that may be usedto update the BUC values before being sent to the submitting pharmacy or otherhealthcareprovider.