Abstract: An example method of reimbursing pharmacy-related transactions includes receiving first data describing a transaction between a patient and a pharmacy. The transaction includes dispensing of a medication. A reimbursement data packet is determined based on the first data. The reimbursement data packet includes second data describing a reimbursement claim to be submitted to a payer system for the transaction. The reimbursement data packet is transmitted from the computer system to a plurality of other computer systems. A response is received from each of the other computer systems. Each response indicates whether a respective one of the other computer systems determined that the reimbursement claim is valid. A determination is made that the reimbursement claim is valid based on the responses. An entry describing the transaction and reimbursement claim is added to a ledger, and the reimbursement claim is submitted for fulfillment.

Abstract: An example method of reimbursing pharmacy-related transactions includes receiving first data describing a transaction between a patient and a pharmacy. The transaction includes dispensing of a medication. A reimbursement data packet is determined based on the first data. The reimbursement data packet includes second data describing a reimbursement claim to be submitted to a payer system for the transaction. The reimbursement data packet is transmitted from the computer system to a plurality of other computer systems. A response is received from each of the other computer systems. Each response indicates whether a respective one of the other computer systems determined that the reimbursement claim is valid. A determination is made that the reimbursement claim is valid based on the responses. An entry describing the transaction and reimbursement claim is added to a ledger, and the reimbursement claim is submitted for fulfillment.

Abstract: An electronic prescription is obtained over a network. A synthetic prescription is generated from the electronic prescription and provided to an insurance switching system. Insurance information of a patient is received from the insurance switching system based on the synthetic prescription. An auto-reversal of the synthetic prescription with the insurance switching system is triggered. A patient payment amount associated with the particular pharmaceutical is determined based on the insurance information. One or more pharmacies to fulfill the electronic prescription are identified based on patient information. An interactive routing request data message is provided to the patient, the data message including the patient payment amount and a request for selection of a particular pharmacy of the one or more pharmacies. The selection of the particular pharmacy is received from a computing device associated with the patient.

Abstract: An electronic prescription is obtained over a network. A synthetic prescription is generated from the electronic prescription and provided to an insurance switching system. Insurance information of a patient is received from the insurance switching system based on the synthetic prescription. An auto-reversal of the synthetic prescription with the insurance switching system is triggered. A patient payment amount associated with the particular pharmaceutical is determined based on the insurance information. One or more pharmacies to fulfill the electronic prescription are identified based on patient information. An interactive routing request data message is provided to the patient, the data message including the patient payment amount and a request for selection of a particular pharmacy of the one or more pharmacies. The selection of the particular pharmacy is received from a computing device associated with the patient.

Abstract: An example method of reimbursing pharmacy-related transactions includes receiving first data describing a transaction between a patient and a pharmacy. The transaction includes dispensing of a medication. A reimbursement data packet is determined based on the first data. The reimbursement data packet includes second data describing a reimbursement claim to be submitted to a payer system for the transaction. The reimbursement data packet is transmitted from the computer system to a plurality of other computer systems. A response is received from each of the other computer systems. Each response indicates whether a respective one of the other computer systems determined that the reimbursement claim is valid. A determination is made that the reimbursement claim is valid based on the responses. An entry describing the transaction and reimbursement claim is added to a ledger, and the reimbursement claim is submitted for fulfillment.

Abstract: An example method of reimbursing pharmacy-related transactions includes receiving first data describing a transaction between a patient and a pharmacy. The transaction includes dispensing of a medication. A reimbursement data packet is determined based on the first data. The reimbursement data packet includes second data describing a reimbursement claim to be submitted to a payer system for the transaction. The reimbursement data packet is transmitted from the computer system to a plurality of other computer systems. A response is received from each of the other computer systems. Each response indicates whether a respective one of the other computer systems determined that the reimbursement claim is valid. A determination is made that the reimbursement claim is valid based on the responses. An entry describing the transaction and reimbursement claim is added to a ledger, and the reimbursement claim is submitted for fulfillment.

Abstract: An electronic prescription is obtained over a network. A synthetic prescription is generated from the electronic prescription and provided to an insurance switching system. Insurance information of a patient is received from the insurance switching system based on the synthetic prescription. An auto-reversal of the synthetic prescription with the insurance switching system is triggered. A patient payment amount associated with the particular pharmaceutical is determined based on the insurance information. One or more pharmacies to fulfill the electronic prescription are identified based on patient information. An interactive routing request data message is provided to the patient, the data message including the patient payment amount and a request for selection of a particular pharmacy of the one or more pharmacies. The selection of the particular pharmacy is received from a computing device associated with the patient.

Abstract: A computer system and method for generating simulated drug claims, suitable modeling and constructing drug benefit plans, the method, characterized by defining a number of lives covered and total spend amount for the simulated drug claims, wherein the method searches a drug claim database containing a plurality of de-identified, drug claims to retrieve drug claims, based on the number of lives, calculates tiers and tier ratios, determines top dispensed drugs, and creates and populates a set of simulated drug claims, until the spend amount is exhausted.

Abstract: Obtaining, by a central system, a plurality of first data messages over a network from a plurality of first remote systems; generating first information based on the first data messages; receiving a second data message including second information from a second remote system; comparing the second information with at least a portion of the first information; determining whether a patient associated with the second information is eligible for a promotion based on the comparing; if eligible, generating a third data message authorizing the second remote system to provide a discount based on the first information; and providing the third data message to the second remote system; if ineligible, generating a fourth data message, the fourth data message indicating the patient is not eligible to receive a discount; and providing the fourth data message to the second remote system.

Abstract: An example method of reimbursing pharmacy-related transactions includes receiving first data describing a transaction between a patient and a pharmacy. The transaction includes dispensing of a medication. A reimbursement data packet is determined based on the first data. The reimbursement data packet includes second data describing a reimbursement claim to be submitted to a payer system for the transaction. The reimbursement data packet is transmitted from the computer system to a plurality of other computer systems. A response is received from each of the other computer systems. Each response indicates whether a respective one of the other computer systems determined that the reimbursement claim is valid. A determination is made that the reimbursement claim is valid based on the responses. An entry describing the transaction and reimbursement claim is added to a ledger, and the reimbursement claim is submitted for fulfillment.

Abstract: A computer system and method for generating simulated drug claims, suitable modeling and constructing drug benefit plans, the method, characterized by defining a number of lives covered and total spend amount for the simulated drug claims, wherein the method searches a drug claim database containing a plurality of de-identified, drug claims to retrieve drug claims, based on the number of lives, calculates tiers and tier ratios, determines top dispensed drugs, and creates and populates a set of simulated drug claims, until the spend amount is exhausted.