Patent ID: 8239213
Filing Date: 2012-08-07
Classification: G06Q,G16H

Abstract:
1. A computer implemented method for simulating at least one change to a prescription drug plan having a plurality of members by a prescription drug plan management computer system, comprising: receiving a request from a prescription drug plan administrator to simulate the at least one plan specific change to the prescription drug plan from a user computing device, wherein the at least one plan specific change comprises a change to a parameter from a plurality of parameters associated with the prescription drug plan for the plurality of members; in response to receiving the request, retrieving data relating to the prescription drug plan from a database; executing, using the prescription drug plan management computer system, a prescription drug plan simulation model using the retrieved data, wherein the model comprises a plurality of calculations performed by the computer to simulate the at least one plan specific change to the prescription drug plan for the plurality members; and electronically transmitting to the user computing device of a prescription drug plan administrator data resulting from the simulation of the at least one plan specific change to the prescription drug plan, wherein the data provides an indication of an overall impact on the prescription drug plan responsive to the at least one plan specific change based at least in part on the application of the model to the retrieved data for the plurality members, and wherein the overall impact on the prescription drug plan for the plurality members as a result of the plan specific change comprises at least one of gross cost, cost share, plan cost, per-member per-month cost, point of service attrition rate, clinical review rate, clinical review denial rate, total denial rate, and number of plan members impacted for the prescription drug plan; wherein the at least one change comprises at least one of: (i) a benefit design change for the prescription drug plan, wherein the model comprises at least one of: a formulary options model comprising a plurality of calculations that determine a rebate impact of a change to at least one of formulary content and co-pays for the prescription drug plan; a therapeutic class optimizer model comprising a plurality of calculations that estimate a rebate impact and a net cost impact of moving a particular drug on or off a formulary of the prescription drug plan for one or more therapeutic classes; a dose optimization model comprising a plurality of calculations that determine an estimated financial impact and an estimated member impact of implementing dose optimization rules; a quantity per dispensing event model comprising a plurality of calculations that determine an estimated financial impact and an estimated member impact of implementing quantity per dispensing event rules; a smart rules model comprising a plurality of calculations that determine an estimated financial impact and an estimated member impact of implementing coverage authorization rules; a traditional prior authorization model comprising a plurality of calculations that determine an estimated financial impact and an estimated member impact of implementing prior authorization rules; a specialty model comprising a plurality of calculations that determine an estimated drug spend impact and an estimated discount impact associated with implementing a specialty pharmacy offering; a new drug events model comprising a plurality of calculations that determine an estimated impact of a status change for a particular drug, the status change comprising at least one of an expiration of a patent for the drug, a new indication for the drug, a shift of the drug from prescription to over-the-counter, an introduction of the drug to the marketplace, and a withdrawal of the drug from the marketplace; a Medicare coordination of benefits model comprising a plurality of calculations that determine an estimated financial impact of implementing a Medicare Part B subrogation program for home delivery claims; and an inclusions/exclusions model comprising a plurality of calculations that determine an estimated impact of including or excluding a particular drug in the prescription drug plan that is typically considered for exclusion from coverage; and (ii) a plan design change for the prescription drug plan, wherein the model comprises at least one of: a member cost share model comprising a plurality of calculations that determine an impact of changes to at least one of open and incentive co-pay prescription drug plan structures comprising a plurality of tiers; a retail refill allowance model comprising a plurality of calculations that determine an impact of a stand-alone retail refill allowance at a user specified threshold; a home delivery advantage model comprising a plurality of calculations that determine an impact of a stand-alone home delivery advantage comprising retail and home delivery co-pay alignment; a member pay the difference model comprising a plurality of calculations that determine an impact of at least one of a managed and sensitive member pay the difference program; a generic bundle model comprising a plurality of sub-models related to generic drug utilization including at least one of dose duration, step therapy, incentive co-pay, and member pay the difference; an out of pocket maximum model comprising a plurality of calculations that determine an impact of an out of pocket maximum both with and without a change to deductible or co-pay; a deductibles model comprising a plurality of calculations that determine an impact of deductibles both with and without a change to out of pocket cost and co-pay; a patient safety program model comprising a plurality of calculations that determine an estimated financial impact of implementing a patient safety program for the prescription drug plan; a benefit cap model comprising a plurality of calculations that determine an impact of a benefit cap for the prescription drug plan; and a retail access density model comprising a plurality of calculations that determine a member impact of removing at least one chain prescription drug retailer from the prescription drug plan.