Patent ID: 8265959

Claim:
A computerized method for processing prior authorization drug requests comprising: (a) receiving at a rules database server an electronic prior authorization drug request, said request comprising: (1) identifying information for a member of a pharmacy benefits plan and identifying information for a drug prescribed to said member; and (2) identifying information for a prescribing physician submitting said electronic prior authorization drug request for said member; (b) assigning a reference identifier to said prior authorization drug request; (c) logging said electronic prior authorization drug request with said reference identifier in a drug request transaction computer system; (d) applying at said transaction computer system authorization criteria to said electronic prior authorization drug request to reach a prior authorization decision approving or denying dispensing of said drug to said member according to said pharmacy benefits plan for said member and said identifying information for said member; (e) updating said electronic prior authorization drug request in said drug request transaction computer system according to said prior authorization decision; (f) if said prior authorization drug request is automatically approved, forwarding said electronic prior authorization drug request from said rules database server to a pharmacy benefits manager computer to facilitate dispensing of said drug to said member; and (g) if said prior authorization drug request is automatically denied, providing a computer user with access to said prior authorization request in said drug request transaction computer system.