Patent ID: 8666778

Claim:
A method for processing a request for a prescription for the specialty pharmaceutical palivizumab using software dedicated to processing requests for prescriptions solely for palivizumab, the method comprising: (A) obtaining with a user interface device of a provider system prescription information for palivizumab for a patient, the user interface device comprising a user input device and a display device, the software causing the display device to display an electronic form dedicated to receiving the prescription information solely for palivizumab, wherein the prescription information comprises a plurality of elements, the electronic form comprising blocks for receiving via the user input device elements comprising (i) information identifying the patient, and (ii) a prescription for an amount of palivizumab; (B) receiving with the user interface device patient clinical information, the software causing the display device to display an electronic form dedicated to receiving patient clinical information relevant to palivizumab, wherein the patient clinical information comprises a plurality of determinants which collectively assist in determining whether a patient is a good candidate for palivizumab and contribute to a basis for authorizing or denying coverage to said patient for palivizumab, the electronic form comprising at least five blocks for receiving via the user input device a corresponding at least five determinants from the group of determinants consisting of a gestational age of the patient, a weight of the patient, a categorical indication as to whether the patient has congenital heart disease, a categorical indication as to whether the patient has chronic respiratory disease arising in the perinatal period, a categorical indication as to whether the patient has a chronic pulmonary disease, a categorical indication as to whether the patient has a congenital anomaly of the respiratory system, and for at least one of said categorical indications, one or more additional determinants associated with the categorical indication; wherein at least one determinant is not a standardized code; (C) storing the prescription information and the patient clinical information in a non-transitory computer-readable medium; (D) requesting coverage for the patient for palivizumab by sending the prescription information and the patient clinical information from the provider system to a specialty pharmacy that is configured to use the prescription information and the patient clinical information to make a coverage decision as to whether to grant coverage to said patient for palivizumab, wherein said coverage decision made by the pharmacy is based upon (i) a set of guidelines provided by an insurer of the patient, (ii) the prescription information, and (iii) the patient clinical information; and (E) displaying with the display device the coverage decision made by the pharmacy.