Patent ID: 8060379
Filing Date: 2011-11-15
Classification: G06Q,G16H

Abstract:
1. A method for alternate pricing, comprising: receiving, from a pharmacy computer, first information associated with a first claim transaction, wherein the first information identifies a first drug, a first quantity of the first drug, and a first price for the first drug; determining a first product classification for the identified first drug, wherein the first product classification indicates that the identified first drug is a preferred drug; automatically updating an alternate pricing database with the first price for the first drug based at least in part on determining that the first price for the first drug does not exceed a previously stored price for the first drug in the alternate pricing database; receiving, from a pharmacy computer, a second claim request, wherein the second claim request identifies a requested drug and a price for the requested drug, and further specifies a claims processing system as a destination of the second claim request; identifying the first drug as a therapeutic alternative for the requested drug; determining, based upon the first price for the first drug in the updated alternate pricing database, that the first drug is available at a lower cost than the requested drug; determining a denial of the second claim request based upon the determination that the first drug is available at the lower cost than the requested drug; and transmitting, to the pharmacy computer that sent the second claim request, a response to the second claim request, the response indicating the denial of the second claim request and further including an indication of availability of the first drug as the therapeutic alternative and pricing information associated with the first drug, and associated with the denial of the second claim request response, the second claim request is not delivered to its intended destination, the claims processing system; wherein the prior steps are performed by a provider computer.