Abstract:
A patient presents a prescription for a drug to a pharmacist who enters a claim in a Pharmacy Management System (PMS). The PMS communicates the claim to a Switch. The Switch communicates the claim to a Discount Engine (DE). In a pre-discount embodiment, the DE, assuming the pharmacist is in a Covered Pharmacy Network, calculates a discount for the drug and attaches the discount to the claim before sending the claim to a Claim Processor (CP). In a post-discount embodiment, the DE forwards the claim without any discount information to the CP; the CP analyzes the claim for insurance coverage and returns a response to the DE; and the DE (assuming pharmacist is in network and claim is qualified) calculates a discount amount. In both embodiments, the DE passes the response (with insurance coverage and/or discount information) to the Switch. The Switch passes the response to the PMS. The pharmacist uses the PMS to dispense the drug and collect an appropriate payment from the patient.

Description:
FIELD OF THE INVENTION 
       [0001]    The present invention generally relates to a Pharmacy Management System, a Switch, a Discount Engine and a Claim Processor (also known as a Pharmacy Benefit Manager), whereby the Discount Engine provides discounts for prescription drugs either before or after a claim is routed to the Claim Processor. 
       SUMMARY OF THE INVENTION 
       [0002]    The present invention provides systems for discounting prescription drugs for patients. A patient may present a prescription to a pharmacist (which should, throughout this specification, be understood to also include an agent of the pharmacist) for a prescription drug. The pharmacist may enter a claim for the prescription drug(s) into a Pharmacy Management System. The Pharmacy Management System may communicate the claim directly to a Discount Engine, but in preferred embodiments, the Pharmacy Management System communicates the claim to a Switch. 
         [0003]    The Switch may be able to handle many different claims from many different Pharmacy Management Systems substantially simultaneously. The Switch may route the claim to a Discount Engine. The Discount Engine may perform a pre-discounting analysis or a post-discounting analysis of the claim from the patient for the prescription. 
         [0004]    In a pre-discounting embodiment, the Discount Engine may analyze the claim (and possibly insert a coupon segment with a discount amount) before forwarding the claim to the Claim Processor. In a post-discounting embodiment, the Discount Engine forwards the claim, either entirely or substantially unchanged, but may analyze a response (and possibly add a discount) after the response is returned from the Claim Processor. 
         [0005]    The Discount Engine may analyze the claim for a discount after receiving the claim from the Switch, but before sending the claim to the Claim Processor. The Discount Engine may determine whether the pharmacy is in a covered pharmacy network of pharmacies stored on a Discount Engine Database. If the pharmacy is not in the covered pharmacy network, the Discount Engine may forward the claim to the Claim Processor without a discount. If the pharmacy is in the covered pharmacy network, the Discount Engine may calculate a discount based on current network rates, maximum allowable costs (MAC) files, patient plan details and administration fees. The Discount Engine may alter the claim, by, as a non-limiting example, inserting a coupon segment into the claim indicating the discount amount. The Discount Engine may then forward the updated claim to the Claim Processor. 
         [0006]    The Claim Processor may adjudicate the claim and determine whether the claim is covered by the patient&#39;s insurance. The Claim Processor may also determine whether to use the discount amount from the Discount Engine. The Claim Processor may create a response indicating whether the claim was approved or rejected and whether the discount amount from the Discount Engine was used. The Claim Process may then forward the response to the Discount Engine. 
         [0007]    The Discount Engine may determine whether the Claim Processor used the discount amount. If the Claim Processor did not use the discount amount, the Discount Engine may pass the response to the Switch. If the Claim Processor did use the discount amount, the Discount Engine may store the details in a Discount Engine database before passing the response to the Switch. In other embodiments, the Discount Engine may store the details in a Discount database regardless of whether or not the Claim Processer used the discount amount. 
         [0008]    In the post-discounting embodiment, the Discount Engine does not analyze the claim for a discount after receiving the claim from the Switch. Instead, the Discount Engine sends the claim, substantially as received, to the Claim Processor. The Claim Processor may process the claim against the patient&#39;s pharmacy benefit (formula, coverage rules, etc.). The Claim Processor may create a response indicating whether the claim was or was not approved. The Claim Processor may communicate the created response to the Discount Engine. 
         [0009]    The Discount Engine may analyze the response received from the Claim Processor. If the response indicates the claim was approved by the Claim Processor and/or the claim was a duplicate, the Discount Engine may pass the response, with the approved claim, to the Switch. 
         [0010]    The Discount Engine may determine if the pharmacy is in the covered pharmacy network and/or whether the claim is qualified for a discount. A claim may be qualified based on any number or type of desired elements as determined by the Discount Engine and/or pharmacist. If the pharmacy is not in the covered pharmacy network and/or the claim is not qualified for a discount, the Discount Engine may pass the response, without indicating a discount, to the Switch. 
         [0011]    If the pharmacy is in the covered pharmacy network and the claim is qualified for a discount, the Discount Engine may calculate a discount based on the network rates, maximum allowable costs (MAC) files, patient plan details and/or administration costs. The details regarding the claim may be stored in the Discount Engine Database. The Response may be updated to indicate the approved discount amount and passed to the Switch. 
         [0012]    In both the pre-discounting and the post-discounting embodiments, the Switch, after receiving the response from the Discount Engine, may communicate the response to the same Pharmacy Management System that sent the corresponding claim. The pharmacist may use the Pharmacy Management System to appropriately dispense the prescription drug to the patient and collect any payment owed. The payment owed reflects the insurance coverage determined by the Claim Processor and/or the discount amount determined by the Discount Engine. 
         [0013]    The above features and advantages of the present invention will be better understood from the following detailed description taken in conjunction with the accompanying drawings. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0014]      FIG. 1  is a block diagram illustrating the flow of a prescription, claim, response and payment as the method of the invention is practiced. 
           [0015]      FIG. 2  is a block diagram illustrating how the Pharmacy Management System, Switch, Discount Engine, and Claim Processor/Pharmacy Benefit Manager are special purpose machines and may be arranged to only communicate with each other over the Internet and/or via a direct connection. 
           [0016]      FIG. 3  is a flow chart of a pre-discount embodiment, where a Discount Engine analyzes a claim and possibly applies a discount to the claim before the claim is sent to a Claim Processor. 
           [0017]      FIG. 4  is a flow chart of a post-discount embodiment, where a Discount Engine analyzes a response and possibly applies a discount to the response after the response is received from a Claim Processor. 
           [0018]      FIG. 5  is a flow chart of a pre-discount embodiment with a new claim and a request for a reversal of an original claim. 
           [0019]      FIG. 6  is a flow chart of a post-discount embodiment with a new claim and a request for a reversal of an original claim. 
       
    
    
     DETAILED DESCRIPTION 
       [0020]    The present inventions will now be discussed in detail with regard to the attached drawing figures that were briefly described above. In the following description, numerous specific details are set forth illustrating the Applicant&#39;s best mode for practicing the invention and enabling one of ordinary skill in the art to make and use the invention. It will be obvious, however, to one skilled in the art that the present invention may be practiced without many of these specific details. In other instances, well-known machines, structures, and method steps have not been described in particular detail in order to avoid unnecessarily obscuring the present invention. Unless otherwise indicated, like parts and method steps are referred to with like reference numerals. 
         [0021]    With reference to  FIG. 1  and  FIG. 2 , a Patient  100  may be a person receiving medical care from a doctor. As part of the medical care, the doctor may prescribe one or more drugs for the Patient  100  to use. The doctor may create a prescription for the Patient  100  (which may include over-the-counter drugs as well as prescription only drugs) to receive the drugs from a pharmacist  110  or a pharmacist&#39;s agent (for simplicity, both are hereafter referred to as the pharmacist  110 ). The Patient  100  may deliver the prescription from the doctor to the pharmacist  110  or the doctor may forward the prescription directly to the pharmacist  110 . The invention is capable of handling any number of doctors, patients  100  and pharmacists  110 . 
         [0022]    The Patient  100  may have insurance from one or more insurance providers (and thus be listed in an insurance database). The pharmacist  110  may be in a covered pharmacy network  141 . The Patient  100  may, simply by requesting the purchase of the drugs and possibly by providing drug insurance or discount information, submit a claim  115  for the prescription to the pharmacist  110 . 
         [0023]    The pharmacist  110  may enter the claim  115  into a Pharmacy Management System  120 . The Pharmacy Management System  120  is defined to be a special purpose machine comprising electrical and mechanical devices. Some of the special purposes of the Pharmacy Management System  120  are to receive a claim  115  entered by a pharmacist  110 , communicate the claim  115  over the Internet  200  to a Switch  130 , receive a response  155  over the Internet  200  from the Switch  130  and communicate information regarding the response  155  to the pharmacist  110  to permit the pharmacist  110  to dispense the drug(s) and collect the proper payment from the Patient  100 . While the Pharmacy Management System  120  will typically include software, it is also hereby defined so that it includes special purpose electronic hardware. The Pharmacy Management System  120  includes an input device  201  (such as an electronic keyboard or scanning device) for a pharmacist  110  to enter a claim  115  from a Patient  100  into the Pharmacy Management System  120 . The Pharmacy Management System  120  includes communication hardware  205  (such as hardware servers  206 , hardware routers  207  and cables  208 ) to permit the claim  115  to be communicated from the Pharmacy Management System  120 , over the Internet  200 , to the Switch  130 . The Pharmacy Management System  120  includes communication hardware  205  to permit a response  155  to be communicated from the Switch  130  to the Pharmacy Management System  120 . The Pharmacy Management System  120  also includes an output device  202  to inform the pharmacist  110  of information related to the response  155 . After the pharmacist  110  receives the response  155 , the pharmacist  110  may dispense the drug(s) and collect the appropriate payment from the Patient  100 . The appropriate payment is based on any insurance coverage and/or discounts the Patient  100  is entitled for the prescribed drug(s) as determined by the Discount Engine  140  and/or the Claim Processor  150 . 
         [0024]    The Internet  200  is defined to be a worldwide network of computer hardware and computer networks arranged to allow for the easy and robust exchange of information across large geographical distances. Communications over the Internet  200  may, as non-limiting examples, include Internet Protocol Address and ports to identify recipients of information. The Internet may also include direct connect high speed data lines dedicated to communicating data between the Pharmacy Management System  120 , the Switch  130 , the Discount Engine  140  and/or the Claim Processor  150 . If data lines are used, these may be restricted from general public use and used solely by the Pharmacy Management System  120 , the Switch  130 , the Discount Engine  140  and/or the Claim Processor  150 . For the purposes of this specification, all “hardware” devices (such as hardware servers and hardware routers) may include or use software, but they also include electrical and/or mechanical devices that are more than mere software. 
         [0025]    The Switch  130  may receive claims  115  from one or more Pharmacy Management Systems  120 . The Switch  130  is defined to be a special purpose machine comprising electrical and mechanical devices. Some of the special purposes of the Switch  130  are to receive claims  115  over the Internet  200  from the one or more Pharmacy Management Systems  120 , communicate the claims  115  over the Internet  200  to a Discount Engine  140 , receive a response  155  from the Discount Engine  140  and communicate information regarding the response  155  to the appropriate Pharmacy Management System  120  associated with the claim  115 . While the Switch  130  may include and run software, the Switch  130  is also hereby defined to include special purpose electronic hardware. The Switch  130  includes communication hardware  210  (such as hardware servers  211 , hardware routers  212  and cables  213 ) to receive claims  115  from one or more Pharmacy Management Systems  120 . The Switch  130  includes communication hardware  210  to permit the claim  115  to be communicated from the Switch  130 , over the Internet  200 , to the Discount Engine  140 . The Switch  130  includes communication hardware  210  to receive a response  155  from the Discount Engine  140 . The Switch  130  also includes communication hardware  210  to communicate the response  155  to the appropriate Pharmacy Management System  120 . 
         [0026]    The Discount Engine  140  may receive claims  115  over the Internet  200  from the Switch  130 . The Discount Engine  140  is defined to be a special purpose machine comprising electrical and mechanical devices. Some of the special purposes of the Discount Engine  140  are to receive claims  115  over the Internet  200  from the Switch  130 , communicate the claims  115  over the Internet  200  to a Claim Processor  150  (which may also be known as a Pharmacy Benefit Manager) out of a possible plurality of Claim Processors, receive a response  155  from the Claim Processor  150 , communicate the response  155  to the Switch  130  and analyze the claim  115  from the Switch  130  and/or the response  155  from the Claim Processor  150  to determine whether a pharmacist  110  is in a covered pharmacy network  141  and/or whether the Patient  100  is entitled to a discount for the drug(s) identified in the claim  115  or response  155 . While the Discount Engine  140  may include software, it is also hereby defined so that it also includes special purpose electronic hardware. The Discount Engine  140  includes communication hardware  225  (such as hardware servers  226 , hardware routers  227  and cables  228 ) to receive claims  115  from the Switch  130 . The Discount Engine  140  includes communication hardware  225  to permit the claim  115  to be communicated from the Discount Engine  140 , over the Internet  200 , to the Claim Processor  150 . The Discount Engine  140  includes communication hardware  225  to receive a response  155  from the Claim Processor  150 . The Discount Engine  140  includes communication hardware  225  to communicate the response  155  to the Switch  130 . The Discount Engine  140  includes data processing equipment  220  (such as microprocessors and integrated circuits  221 ) to analyze claims  115  and/or responses  155 , to determine if pharmacists are listed in a covered pharmacy network  141 , to insert coupons into claims  115  and/or to determine if a Patient  100  is eligible for a discount. The Discount Engine  140  comprises a Discount Engine Database  223  for storing the covered pharmacy network  141 , network rates  142  and/or MAC files  143 . While the Discount Engine Database  223  may use software, the Discount Engine Database  223  is hereby defined to be a physical electronic storage device having a physical storage medium. In preferred embodiments, the Discount Engine  140  may be a standalone system and only communicate with the Switch  130  and the Claim Processor  150  through the Internet  200  during the processes of communicating and analyzing claims  115  and/or responses  155 . In this preferred embodiment the Discount Engine  140  does not share a building or hardware, other than through Internet connections, with the Switch  130  or the Claim Processor  150 . In other embodiments, the Discount Engine  140  may be incorporated into the Claim Processor  150  and thus communicate with the Claim Processor  150  and/or the Switch  130  by any desired method of electronic communication. 
         [0027]    A single stand alone Discount Engine  140  may handle claims  115  from a single or multiple Switches  130  and/or a single or multiple Pharmacy Management Systems  120 . A single stand alone Discount Engine  140  may also interface and work with a single or multiple Claim Processors  150  (or Pharmacy Benefit Manager). The benefits of a stand alone Discount Engine  140  are that network rates  142  and MAC files  143  only have to be loaded, stored and maintained at one place, i.e., the Discount Engine  140 . There is no need to load, store or maintain the covered pharmacy network  141 , network rates  142  and/or MAC files  143  on one or more Pharmacy Management Systems  120  and/or one or more Claim Processors  150 . This makes the overall system (Pharmacy Management System(s)  120 , Discount Engine  140  and Claim Processor(s)  150 ) much easier to update and maintain. This also reduces the number of updates to Claim Processor(s)  150 , reduces or eliminates feedback reporting from the Claim Processor(s)  150  and allows pharmacy billing to be handled directly by the Discount Engine  140  and secures proprietary information (MAC files, network rates, etc.). 
         [0028]    In some embodiments, the Discount Engine  140  may have a support layer. As non-limiting examples, the Discount Engine  140  may have the ability to analyze and report discount usage for patients, manage network and rate information, automate pharmacy billing and provide customer/client service. In some embodiments, the support layer may include an administrative portal for loading and extracting data. The administrative portal may allow configuration data to be setup related to the qualification and viewing of claims. Network and MAC file data may be handled through data loads via file transfer. Pharmacy billing may be handled through data extracts into systems that handle pharmacy invoicing. 
         [0029]    The Claim Processor  150  (also known as a Pharmacy Benefit Manager) may receive a claim  115  (possibly with a coupon segment added by the Discount Engine  140 ) from the Discount Engine  140 . The Claim Processor  150  is defined to be a special purpose machine comprising electrical and mechanical devices. Some of the special purposes of the Claim Processor  150  are to receive claims  115  over the Internet  200  from the Discount Engine  140 , adjudicate the claim  115  to determine insurance coverage for all claims  115  received, prepare a response  155  to for each claim  115  and communicate the response  155  over the Internet  200  to the Discount Engine  140 . While the Claim Processor  150  may include software, it is also hereby defined to include special purpose electronic hardware. The Claim Processor  150  includes communication hardware  230  (such as hardware servers  231 , hardware routers  232  and cables  233 ) to receive claims  115  from the Discount Engine  140 . The Claim Processor  150  includes data processing equipment  240  (such as microprocessors and integrated circuits  241 ) to analyze claims  115  for insurance coverage and to prepare appropriate responses  155 . The Claim Processor  150  also includes communication hardware  230  that allows the prepared response  155  to be communicated from the Claim Processor  150  over the Internet  200  to the Discount Engine  140 . 
         [0030]    Pre-Edit Discount 
         [0031]    With reference to  FIG. 3  (a pre-edit process), a Patient  100  may present a prescription to a pharmacist  110 . (Step  300 ) The pharmacist  110  may enter a claim  115  on the patient&#39;s behalf for the prescription into a Pharmacy Management System  120 . (Step  301 ) The Pharmacy Management System  120  may communicate the claim  115  over the Internet  200  to a Switch  130 . (Step  302 ) The Switch  130  may communicate the claim  115  over the Internet  200  to a Discount Engine  140 . (Step  303 ). 
         [0032]    The Discount Engine  140  may analyze the claim  115  from the Switch  130  and determine whether the pharmacist  110  is listed in a covered pharmacy network  141  stored in the Discount Engine Database  223 . The pharmacists in the covered pharmacy network  141  are those that have negotiated a discount drug program with the Discount Engine  140 . If the pharmacist  110  is not in the covered pharmacy network  141  the Discount Engine  140  may forward the claim  115  to the Claim Processor  150  without attaching a coupon segment indicating a discount to the claim  115 . 
         [0033]    Alternatively, if the pharmacist  110  is in the covered pharmacy network  141  the Discount Engine  140  may calculate a discount based on network rates  142 , maximum allowable costs (MAC) files  143  and/or administration fees. The Discount Engine  140  may insert a coupon segment to the claim  115  with the calculated discount amount. The Discount Engine  140  may then forward the claim  115  (with the inserted coupon segment) to the Claim Processor  150  for further processing. (Step  304 ) 
         [0034]    Table 1 is a non-limiting example of what a claim with a coupon segment (segment is AM09) may look like: 
         [0000]    
       
         
               
               
               
             
               
             
           
               
                   
                 TABLE 1 
               
               
                   
                   
               
             
             
               
                   
                 009999D0B100000000001070100886 
                     20150119 
               
             
          
           
               
                 -AM04C2PREB1TEST011C301C61-AM01C419700111C51CACARDHOLDERCBPREB 
               
               
                 1TEST011-AM07EM1D2000000010010E103D700777310402D300D5030DE20150119 
               
               
                 E70000030000-AM11DQ0009990{DU0009990{-AM03DBAZ9999999-AM09KE01MESS 
               
               
                 DISCOUNTNE0000250{---------------------------------- 
               
               
                   
               
             
          
         
       
     
         [0035]    The Claim Processor  150  may adjudicate the claim  115  to determine whether the Patient  100  and drug(s) are covered under the patient&#39;s insurance coverage using predefined rules. If the Claim Processor  150  approves the claim  115 , the Claim Processor  150  may prepare a response  155  indicating the claim  115  was approved and forward the response  155  to the Discount Engine  140 . If the Claim Processor  150  determines that the claim is not covered by the patient&#39;s insurance, but the claim  115  has an inserted coupon segment for a discount, the Claim Processor  150  may determine whether the claim  115  is qualified for the discount. If the claim  115  is qualified for the discount, the Claim Processor  150  may prepare a response  155  that indicates the discount was used and forward the response  155  to the Discount Engine  140 . (Step  305 ) 
         [0036]    The Discount Engine  140  may analyze the response  155  to determine whether the Claim Processor  150  used the discount for the Patient  100 . If the discount was used by the Claim Processor  150  for the Patient  100 , the Discount Engine  140  may save claim  115  details in the Discount Engine Database  223  indicating the discount was used. In other embodiments, the claim  115  details may be stored in the Discount Engine Database  223  regardless of whether or not the discount was used. The Discount Engine  140  may pass over the Internet  200  the response  155  back to the Switch  130 . (Step  306 ) The Switch  130  may communicate over the Internet  200  the response  155  (indicating whether the claim  115  was covered and/or whether the discount was used) back to the Pharmacy Management System  120  (Step  307 ) so the pharmacist  110  may appropriately dispense the drug(s) and collect payment (which reflects insurance coverage and/or discount(s) used) from the Patient  100 . (Step  308 ) 
         [0037]    Table 2 is a non-limiting example of a pre-edit response  155  with an approved discount. This example response  155  has a field indicating that a discount was applied. Any field and any value within the field may be used to indicate whether or not a discount was applied. 
         [0000]    
       
         
               
               
               
             
               
             
           
               
                   
                 TABLE 2 
               
               
                   
                   
               
             
             
               
                   
                 D0B11A070100886 
                  20150119-AM20F4SS DISCOUNT 
               
             
          
           
               
                 APPLIED-AM21ANDF3U15009R707BC00-AM23F5100{F650{F750{F9{FM04FI{4U100{ 
               
               
                 -AM22EM1D2000000010003----------------------------------- 
               
               
                   
               
             
          
         
       
     
         [0038]    Table 3 is a non-limiting example of a pre-edit response  155  without a discount, In this example, no indicator (for a discount being applied) is present. 
         [0000]    
       
         
               
               
               
             
               
             
           
               
                   
                 TABLE 3 
               
               
                   
                   
               
             
             
               
                   
                 D0B11A070100886 
                 20150119-AM20F4NO 
               
             
          
           
               
                 MESSAGE-AM21ANDF3U15009R707BC00-AM23F5100{F650{F750{F9{FM04FI{4U10 
               
               
                 0{-AM22EM1D2000000010003---------------------------------- 
               
               
                   
               
             
          
         
       
     
         [0039]    Claim Reversal Processes 
         [0040]    In another embodiment, it may be desirable to reverse (erase, undo or negate) a claim  115  that was previously approved by a Claim Processor  150  and/or a Discount Engine  140 . This embodiment of reversing the claim  115  may be used after either the pre-edit process (discussed above) or the post-edit process (discussed below). The pharmacist may enter the claim  115  (to reverse) into a Pharmacy Management System  120 . The Pharmacy Management System  120  may forward the claim  115  over the Internet  200  to a Switch  130 . The Switch  130  may communicate the claim  115  over the Internet  200  to the Discount Engine  140 . The Discount Engine  140  may forward the claim  115  over the Internet  200  to the Claim Processor  150 . In preferred embodiments, the claim  115  forwarded to the Claim Processor  150  is either identical or substantially the same as when the claim  115  left the Pharmacy Management System  120 . The Claim Processor  150  may adjudicate the claim  115  and either approve or deny the claim  115  reversal. The Claim Processor  150  may return a response  155  to the Discount Engine  140  indicating whether the Claim Processor  150  approved or denied the claim  115  reversal. The Discount Engine  140  may review the response  155  to determine whether the claim  115  reversal was approved or denied by the Claim Processor  150 . If the claim  115  reversal was denied, the response  155  may be forwarded over the Internet  200  to the Switch  130 . If the claim  115  reversal was approved, but the claim  115  was not previously discounted, the response  155  may be forwarded over the Internet  200  to the Switch  130 . If the claim  115  reversal was approved and the claim  115  was originally discounted, the Discount Engine may reverse the claim in a Discount Engine Database  223  and pass the response  155  over the Internet  200  to the Switch  130 . The Switch  130  may communicate over the Internet  200  the response  155  (indicating whether the Claim Process  150  reversed the claim  115  back to the Pharmacy Management System  120  so the pharmacist  110  may appropriately dispense the drug(s) and collect or refund the correct payment from the Patient  100 . 
         [0041]    Pre-Edit Discount with Claim Reversal 
         [0042]    With reference to  FIG. 5 , a Patient  100  may present a prescription to a pharmacist  110  and possibly request a reversal of an original claim (previously approved claim). (Step  300 ) The pharmacist  110  may enter a new claim  115  on the patient&#39;s behalf for the prescription into a Pharmacy Management System  120  and for the reversal of the original claim. (Step  500 ) In some embodiments, a pharmacist  110  may need to change information on a claim, e.g., quantity, days supply, etc.) and the pharmacist  110  may submit a rebill. This rebill may be a reversal of a claim and a submission of a new claim in one transaction. The Pharmacy Management System  120  may communicate the claim  115  over the Internet  200  to a Switch  130 . (Step  302 ) The Switch  130  may communicate the claim  115  over the Internet  200  to a Discount Engine  140 . (Step  303 ) 
         [0043]    The Discount Engine  140  may analyze the claim  115  from the Switch  130  before sending the claim  115  to the Claim Processor  150  and determine whether the pharmacist  110  is listed in a covered pharmacy network  141  stored in the Discount Engine Database  223 . The pharmacists in the covered pharmacy network  141  are those that have negotiated a discount drug program with the Discount Engine  140 . If the pharmacist  110  is not in the covered pharmacy network  141 , the Discount Engine  140  may forward the claim  115  to the Claim Processor  150  without attaching a coupon segment indicating a discount to the claim  115 . 
         [0044]    Alternatively, if the pharmacist  110  is in the covered pharmacy network  141 , the Discount Engine  140  may calculate a discount for the new claim  115  based on network rates  142 , maximum allowable costs (MAC) files  143  and/or administration fees. The Discount Engine  140  may insert a coupon segment to the claim  115  with the calculated discount amount. The Discount Engine  140  may then forward the claim  115  (with the inserted coupon segment) to the Claim Processor  150  for further processing. (Step  304 ) 
         [0045]    The Claim Processor  150  may reverse the original claim if the original claim is found in the Claim Processor&#39;s database. If the Claim Processor  150  successfully reverses the original claim, the Claim Processor  150  may then adjudicate the new claim  115  and determine whether the Patient  100  and/or the patient&#39;s prescription are covered by the Patient&#39;s insurance. If the Claim Processor  150  approves the claim  115 , the Claim Processor  150  may prepare a response  155  indicating the claim  115  was approved and forward the response  155  to the Discount Engine  140 . If the Claim Processor  150  does not approve the claim  115 , but the claim  115  has an inserted coupon segment for a discount, the Claim Processor  150  may determine whether the claim  115  is qualified for the discount. If the claim  115  is qualified for the discount, the Claim Processor  150  may prepare a response  155  that indicates the discount was used and forward the response  155  to the Discount Engine  140 . While any number of communications may occur between the Discount Engine  140  and the Claim Processor  150 , in preferred embodiments all the information is sent from the Claim Processor  150  to the Discount Engine in a single response  155 . (Step  501 ) 
         [0046]    The Discount Engine  140  may analyze the response  155  to determine whether the Claim Processor  150  used the discount for the Patient  100 . If the discount was used by the Claim Processor  150  for the Patient  100 , the Discount Engine  140  may save claim  115  details in the Discount Engine Database  223  indicating the discount was used. The Discount Engine  140  may also analyze the response  155  and/or Discount Engine Database  223  to determine whether the original claim was discounted. If the original claim was discounted, the Discount Engine may logically reverse the discount in the Discount Engine Database  223 . The Discount Engine  140  may pass over the Internet  200  the response  155  back to the Switch  130 . (Step  502 ) The Switch  130  may communicate over the Internet  200  the response  155  (preferably indicating whether the claim  115  was covered, whether the discount was used and/or whether the previously approved claim was reversed as requested) back to the Pharmacy Management System  120  (Step  307 ) so the pharmacist  110  may appropriately dispense the drug(s) and collect payment (which reflects insurance coverage, discount(s) used and/or the original claim reversal) from the Patient  100  (Step  308 ). 
         [0047]    Post-Edit Discount 
         [0048]    With reference to  FIG. 4  (a post-edit process), a Patient  100  may present a prescription to a pharmacist  110 . (Step  300 ) The pharmacist  110  may enter a claim  115  on the patient&#39;s behalf for the prescription into a Pharmacy Management System  120 . (Step  301 ) The Pharmacy Management System  120  may communicate the claim  115  over the Internet  200  to a Switch  130 . (Step  302 ) The Switch  130  may communicate the claim  115  over the Internet  200  to a Discount Engine  140 . (Step  303 ) 
         [0049]    The Discount Engine  140  may forward the claim  115 , preferably unaltered and in the same state that the claim  115  was received, i.e., no changes or discount coupons attached, to a Claim Processor  150 . (Step  400 ) The Claim Processor  150  may adjudicate the claim  115  and determine whether the Patient  100  and/or the patient&#39;s prescription are covered by insurance, create a response  155  to the claim  115  indicating whether the Patient  100  and/or prescription are covered by insurance and communicate the response  155 , over the Internet  200 , to the Discount Engine  140 . (Step  401 ) 
         [0050]    After receiving the response  155  from the Claim Processor  150 , the Discount Engine  140  may analyze the response  155 . If the response  155  indicates the Claim Processor  150  approved the claim  115 , the Discount Engine  140  may pass the response  155  to the Switch  130 . The Switch  130  may communicate over the Internet  200  the response  155  (indicating the Claim Processor  150  approved the claim  115 ) back to the Pharmacy Management System  120  so the pharmacist  110  may appropriately dispense the drug(s) and collect the correct payment from the Patient  100 . 
         [0051]    Table 4 is a non-limiting example of a response  155  in a post-edit discount process. In this example, the response  155  indicates the claim  115  was allowed by the Claim Processor  150  and thus, in this embodiment, not qualified for a discount. 
         [0000]    
       
         
               
               
               
             
               
             
           
               
                   
                 TABLE 4 
               
               
                   
                   
               
             
             
               
                   
                 D0B11A070100886 
                  20150119-AM20F4DE TEST 
               
             
          
           
               
                 MESSAGE-AM21ANPF3U15009R707BC00-AM22EM1D2009971000001-AM23F5100{ 
               
               
                 F650{F750{F9{FI{4U100{-------------------------------- 
               
               
                   
               
             
          
         
       
     
         [0052]    If the response  155 , created by the Claim Processor  150 , indicates the claim  115  was a duplicate, the Discount Engine  140  may communicate the duplicate claim  115  response  155  to the Switch  130 . The Switch  130  may communicate over the Internet  200  the response  155  (indicating the Claim Processor  150  found the claim  115  to be a duplicate) back to the Pharmacy Management System  120  so the pharmacist  110  may appropriately dispense the drug(s) and collect the correct payment from the Patient  100 . 
         [0053]    If the claim  115  was rejected and found not to be a duplicate by the Claim Processor  150 , the Discount Engine  140  may determine whether the pharmacist  110  is in the covered pharmacy network  141 , and determine whether the claim  115  is qualified for a discount. If the pharmacist  110  is not part of the covered pharmacy network  141  of covered pharmacists or if the claim  115  is not qualified for a discount, the Discount Engine  140  may pass the response  155 , without an approved discount, to the Switch  130 . The Switch  130  may communicate over the Internet  200  the response  155  (indicating no qualified discount) back to the Pharmacy Management System  120  so the pharmacist  110  may appropriately dispense the drug(s) and collect the correct payment from the Patient  100 . 
         [0054]    Table 5 is a non-limiting example of a response  155  in a post-edit discount process. In this example, the response  155  indicates the claim was rejected by the Claim Processor  150  and no discount was applied by the Discount Engine  140 . 
         [0000]    
       
         
               
               
             
               
             
           
               
                   
                 TABLE 5 
               
               
                   
                   
               
             
             
               
                   
                 D0B11A070100886 
               
             
          
           
               
                 20150119-AM21ANRF3U14310S434BC01FA1FB75-AM22EM1D2009971000002 
               
               
                 ---------------------------------- 
               
               
                   
               
             
          
         
       
     
         [0055]    Table 6 is a non-limiting example of a response  155  in a post-edit discount process. In this example, the response  155  indicates the claim was rejected by the Claim Processor  150 , but the Discount Engine applied a discount to the response  155 . 
         [0000]    
       
         
               
               
             
               
             
           
               
                   
                 TABLE 6 
               
               
                   
                   
               
             
             
               
                   
                 D0B11A070100886 
               
             
          
           
               
                 20150119-AM21ANRF3U14310S434BC01FA1FB70-AM22EM1D2009971000003 
               
               
                 ---------------------------------- 
               
               
                   
               
             
          
         
       
     
         [0056]    If the claim  115  was rejected and found not to be a duplicate by the Claim Processor  150  and the pharmacist  110   100  is in the covered pharmacy network  141  and the claim  115  is qualified for a discount, the Discount Engine  140  may calculate a discount using network rates  142 , the patient&#39;s plan, MAC files  143  and administration fees. The response  155  may be modified and/or a new response  155  may be created to indicate that a discount may be provided to the Patient  100 . (Step  402 ) In preferred embodiments, the claim  115  details (patient name, drug(s), claim  115  details, date, determinations made by the Claim Processor  150  and/or Discount Engine  140 ) may be stored in the Discount Engine Database  223 . The Discount Engine  140  may pass the response  155 , with the approved discount, to the Switch  130 . (Step  306 ) The Switch  130  may communicate over the Internet  200  the response  155  (indicating the Discount Engine  140  approved a discount) back to the Pharmacy Management System  120  (Step  307 ) so the pharmacist  110  may appropriately dispense the drug(s) and collect the correct payment from the Patient  100  (Step  308 ). 
         [0057]    Post-Edit Discount with Claim Reversal 
         [0058]    With reference to  FIG. 6 , a Patient  100  may present a prescription to a pharmacist  110  and possibly request a reversal of an original claim (previously approved claim). (Step  300 ) A pharmacist  110  may need to change information on a claim (e.g., quantity, days supply, etc.) and may submit a rebill. The rebill may be a reversal of an original claim and a submission of a new claim all in one transaction. The pharmacist  110  may enter a claim  115  (possibly a rebill) on the patient&#39;s behalf for the prescription into a Pharmacy Management System  120  and for the reversal of the original claim. (Step  500 ) The Pharmacy Management System  120  may communicate the claim  115  over the Internet  200  to a Switch  130 . (Step  302 ) The Switch  130  may communicate the claim  115  over the Internet  200  to a Discount Engine  140 . (Step  303 ) 
         [0059]    The Discount Engine  140  may forward the claim  115 , preferably unaltered and in the same state that the claim  115  was received, i.e., no changes or discount coupons attached, to a Claim Processor  150 . (Step  400 ) The Claim Processor  150  may reverse the original claim if found in the Claim Processor database. If the Claim Processor  150  was able to successfully reverse the original claim, the Claim Processor  150  may then adjudicate the new claim and determine whether the patient  100  and/or the patient&#39;s prescription are covered by the patient&#39;s insurance. The Claim Processor  150  may create a response  155  indicating whether the original claim was reversed and/or the Patient  100  and/or prescription are covered by insurance. The Claim Processor  150  may communicate the response  155 , over the Internet  200 , to the Discount Engine  140 . (Step  600 ) 
         [0060]    The Discount Engine  140  may determine whether the original claim, now being reversed, was previously discounted. If the original claim was discounted, the Discount Engine may logically reverse the discount in the Discount Engine Database  223 , generate an accepted/rejected response and forward to the Switch  130  with a message to resubmit as a new claim. (Step  601 ) 
         [0061]    If the response  155  indicates the Claim Processor  150  approved the claim  115 , the Discount Engine  140  may pass the response  155  to the Switch  130 . The Switch  130  may communicate over the Internet  200  the response  155  (indicating the Claim Processor  150  rejected the claim  115 ) back to the Pharmacy Management System  120  so the pharmacist  110  may appropriately dispense the drug(s) and collect the correct payment from the Patient  100 . 
         [0062]    If the response  155  indicates the claim  115  was rejected by the Claim Processor  150 , the Discount Engine  140  may determine whether the pharmacist  110  is in the covered pharmacy network  141 . If the pharmacist  100  is not part of the covered pharmacy network  141  of covered pharmacists or if the claim  115  is not qualified for a discount, the Discount Engine  140  may pass the response  155 , without an approved discount, to the Switch  130 . The Switch  130  may communicate over the Internet  200  the response  155  (indicating no qualified discount) back to the Pharmacy Management System  120  so the pharmacist  110  may appropriately dispense the drug(s) and collect the correct payment from the Patient  100 . 
         [0063]    If the response  155  indicates the claim  115  was rejected, the pharmacist  110  is in the covered pharmacy network  141  and the claim  115  is qualified for a discount, the Discount Engine  140  may calculate a discount using network rates  142 , the patient&#39;s plan, MAC files  143  and administration fees. (Step  402 ) The response  155  may be modified, or a new response  155  created, to indicate that a discount may be provided to the Patient  100 . In preferred embodiments, the claim  115  details (patient name, drug(s), claim  115  details, date, determinations made by the Claim Processor  150  and/or Discount Engine  140 , etc.) may be stored in the Discount Engine Database  223 . The Discount Engine  140  may pass the response  155 , with the approved discount, to the Switch  130 . (Step  306 ) The Switch  130  may communicate over the Internet  200  the response  155  (indicating the Discount Engine  140  approved a discount) back to the Pharmacy Management System  120  (Step  307 ) so the pharmacist  110  may appropriately dispense the drug(s) and collect/refund the correct payment from the Patient  100  (Step  308 ). 
         [0064]    Other embodiments and uses of the above inventions will be apparent to those having ordinary skill in the art upon consideration of the specification and practice of the invention disclosed herein. It should be understood that features listed and described in one embodiment may be used in other embodiments unless specifically stated otherwise. The specification and examples given should be considered exemplary only, and it is contemplated that the appended claims will cover any other such embodiments or modifications as fall within the true scope of the invention.