Abstract: Methods and apparatuses are disclosed for changing a prescribed medication for a patient. These methods and apparatuses may interface with a patient's electronic health records and payer databases and identify alternative therapeutically equivalent medications to replace a patient's existing medications with less expensive alternatives. The patient's care team can interactively manipulate and modify the data to determine alternatives.

Abstract: Methods and apparatuses for automatically identifying therapeutically equivalent alternative medications for reducing patient costs. These methods and apparatuses may interface with a patient's electronic health records and Payer databases and identify alternative medications that offer cost savings to the patient and Payer. The methods and apparatuses described herein may also incentivize patients to select cost-saving medication alternatives.

Abstract: Methods and apparatuses for automatically identifying therapeutically equivalent alternative medications for reducing patient costs. These methods and apparatuses may interface with a patient's electronic health records and Payer databases and identify alternative medications that offer cost savings to the patient and Payer. The methods and apparatuses described herein may also incentivize patients to select cost-saving medication alternatives.

Abstract: Described herein are methods and systems for controlling the operation of one or more prescription cost savings systems, including methods and systems for the interactive and dynamic generation of Drug Savings Reports.

Abstract: Methods and apparatuses for automatically identifying therapeutically equivalent alternative medications for reducing patient costs. These methods and apparatuses may interface with a patient's electronic health records and Payer databases and identify alternative medications that offer cost savings to the patient and Payer. The methods and apparatuses described herein may also incentivize patients to select cost-saving medication alternatives.

Abstract: Methods and apparatuses for automatically identifying therapeutically equivalent alternative medications for reducing patient costs. These methods and apparatuses may interface with a patient's electronic health records and Payer databases and identify alternative medications that offer cost savings to the patient and Payer. The methods and apparatuses described herein may also incentivize patients to select cost-saving medication alternatives.

Abstract: Systems and methods are provided for a healthcare network survey solution. The systems and methods may include receiving a healthcare transaction from a remote computer, where the healthcare transaction identifies at least one of a drug, product, or service for a patient; determining that the healthcare transaction is eligible for a survey based upon an analysis of the drug, product, or service identified in the healthcare transaction request; selecting the eligible healthcare transaction for the survey based at least in part upon a random selection process; and delivering a survey request to a survey recipient associated with the healthcare transaction, where the survey request includes at least a transaction identifier for identifying the survey.

Abstract: Systems and methods for managing a prescription rewards program include receiving, at a switch, an adjudicated prescription claim transaction, where the adjudicated prescription claim transaction includes an indication that the prescription claim transaction has been approved by a claim processor. The systems and methods further include identifying, from the adjudicated prescription claim transaction, a patient associated with the adjudicated prescription claim transaction, retrieving, from a database associated with the switch, a reward accumulator value associated with the patient, and updating the reward accumulator value associated with the patient based at least in part on the adjudicated prescription claim transaction. The systems and methods may further include determining that a threshold value has been satisfied by the reward accumulator value, and issuing a reward message based at least in part on the reward accumulator satisfying the threshold value.

Abstract: Systems and methods for identifying REMS compliance are provided. A service provider system that includes one or more computers may route one or more healthcare transactions submitted by a healthcare provider to one or more claims processor computers. One or more respective adjudicated replies received from the one or more claims processor computers for the one or more healthcare transactions may then be routed by the service provider system to the healthcare provider. Based at least in part upon information included in the routed healthcare claim transactions and adjudicated replies, an amount of a product dispensed by the healthcare provider may be determined by the service provider system. The determined dispensed amount may be compared to a purchased amount of the product. Based at least in part upon the comparison, a determination may be made as to whether a REMS condition associated with the product is satisfied.

Abstract: Systems and methods for processing rejected healthcare claim transactions for over-the-counter (“OTC”) products are provided. A healthcare claim transaction associated with a product requested by a customer may be received from a healthcare provider computer. The healthcare claim transaction may be communicated to a claims processor for adjudication, and a denied claim response for the healthcare claim transaction may be received from the claims processor. Based at least in part upon a classification of the product, the denied claim response may be converted to an approved claim response, and the approved claim response may be communicated to the healthcare provider computer. In certain embodiments, the above operations may be performed by one or more computers associated with a service provider.

Abstract: Systems and methods are provided for providing prior authorization support.

Abstract: Systems and methods are provided for supporting and validating patient enrollment in one or more healthcare programs. The systems and methods may include receiving a prescription claim request from a pharmacy computer, where the prescription claim request includes at least (i) a first product identifier identifying with a prescribed product for a patient, and (ii) patient information associated with the patient; determining, based at least in part upon the first identifier, that patient is subject to a requirement to enroll in one or more required healthcare programs prior to the prescription product being released to the patient; extracting enrollment information from the prescription claim request, the extracted enrollment information including at least a portion of the patient information from the prescription claim request; and automatically utilizing the extracted enrollment information to complete at least a portion of an enrollment process for the one or more required healthcare programs.

Abstract: Systems and methods may be provided for a prescription safety network program.

Abstract: Systems and methods are provided for the coordination of benefits. The systems and methods may include receiving a healthcare claim request from a healthcare provider computer; determining, based at least in part from patient information in the healthcare transaction claim request, that the patient is associated with at least a first payer and a second payer; generating a primary claim request based upon the identified product and the patient associated with the healthcare claim request, the primary claim associated with the first payer; and generating a coordination of benefits (COB) claim request based at least in part on the received first adjudicated reply associated with the primary claim request, the COB claim request, the COB claim request associated with a second payer.

Abstract: Systems and methods for tracking prescription drug inventory of a pharmacy at a switch. Embodiments of the invention include receiving, at a switch, a prescription claim transaction from a pharmacy system, where the prescription claim transaction indicates an amount of a drug, and transmitting the prescription claim transaction to a payer system for adjudication. An adjudicated response for the prescription claim is then received from the payer system, and an inventory amount associated with the drug maintained by the switch is updated by the switch. When a determination is made that the inventory amount has met a threshold value, a message is transmitting indicating that the inventory amount has met the threshold value. In some embodiments of the invention the message is sent to the pharmacy or directly to a supplier as part of an order for additional inventory of the drug.

Abstract: Systems and methods may be provided for alternate pricing. The systems and methods may include receiving first information associated with a first claim transaction, where 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, where the first product classification indicates that the identified first drug is a preferred drug, and updating an alternate pricing database with the first price for the first drug. The systems and methods may also include utilizing the alternate database to identify one or more lower-cost alternate drugs that are therapeutic alternatives for a requested drug. Customers may be provided with information regarding the identified lower-cost alternate drugs.

Abstract: Systems and methods for verifying prescription transaction dosages can be provided according to embodiments of the invention. According to one example embodiment, a method for dosage error verification may be provided. The method may include executing computer program instructions by one or more processors for receiving a prescription transaction including a submitted drug product and a submitted strength of the submitted drug product; comparing the submitted drug product and the submitted strength to dosage error data residing in a dosage error database; determining that the submitted drug product is a member of at least one dosage error pair indicated by the dosage error data; determining that the submitted strength is potentially incorrect based at least in part on strengths indicated by the at least one dosage error pair; and performing an edit action based at least in part on the determination that the submitted strength is potentially incorrect.

Abstract: Systems and methods may be provided for claim denial conversion. The systems and methods may include receiving a prescription claim from a pharmacy, where the prescription claim is associated with a drug or other product requested by a customer, routing the prescription claim to a claims processor for adjudication, and receiving, from the claims processor, a denied claim response for the claim request. The systems and methods may further include determining that funding is available to cover at least a portion of a price of the requested drug or other product, converting the denied claim response to an approved claim response upon determination of the available funding, and transmitting the approved claim response to the pharmacy.

Abstract: Systems and methods may be provided for prescription pre-fill processing services, which may include receiving a pre-fill prescription claim request from a pharmacy computer; delivering the pre-fill prescription claim request to a claims processor; and receiving a first approved response from the claims processor, where the first approved response includes first financial coverage information.

Abstract: Systems and methods may be provided for supporting drug or product recalls. The systems and methods may include receiving a healthcare transaction request from a pharmacy computer associated with a pharmacy, wherein the healthcare transaction request includes an identification of a prescribed drug or product; determining, based upon the identification of the prescribed drug or product, that the prescribed drug or product is associated with a recall; providing, in response to the determination that the prescribed drug or product is associated with the recall, a response that includes information for accessing a web portal interface; receiving, over the web portal interface, lot numbers associated with pharmacy inventory of the prescribed drug or product; determining that one or more of the received lot numbers are affected by the recall; and generating a notification identifying the received lot numbers that are associated with the pharmacy inventory.