Abstract: A computer-implemented method for managing prescription benefits in prescription claim or inquiry requests performed by one or more computers in a prescription order processing system includes receiving a prescription claim request related to a consumer from a requesting entity. A crosswalk file is retrieved that comprises information from a plurality of health plan member files describing benefits available to the consumer provided by a plurality of benefit providers. The crosswalk file is used to automatically determine an order submission sequence indicating an order in which claim or inquiry requests corresponding to the benefits are submitted to the benefit providers. The claim or inquiry requests are submitted to the benefit providers according to the order submission sequence. Responses from the benefit providers are automatically aggregated in order to generate an aggregated response to the prescription claim request. The aggregated response is transmitted to the requesting entity.

Abstract: A computer-implemented method for managing prescription benefits in prescription claim or inquiry requests performed by one or more computers in a prescription order processing system includes receiving a prescription claim request related to a consumer from a requesting entity. A crosswalk file is retrieved that comprises information from a plurality of health plan member files describing benefits available to the consumer provided by a plurality of benefit providers. The crosswalk file is used to automatically determine an order submission sequence indicating an order in which claim or inquiry requests corresponding to the benefits are submitted to the benefit providers. The claim or inquiry requests are submitted to the benefit providers according to the order submission sequence. Responses from the benefit providers are automatically aggregated in order to generate an aggregated response to the prescription claim request. The aggregated response is transmitted to the requesting entity.

Abstract: A computer-implemented method of providing a discount to a consumer purchasing a medication from a pharmacy includes receiving, by a discount payer adjudication engine, a new benefit claim from a pharmacy computer comprising (i) a member identifier corresponding to a member and (ii) an indication of medication. The discount payer adjudication engine determines whether the member is eligible for the new benefit claim at least in part based on one or more previously approved benefit claims associated with the member. If the member is eligible for the new benefit claim, an approved claim response is transmitted to the pharmacy computer. If the member is not eligible for the new benefit claim, a denied claim response is transmitted to the pharmacy computer.

Abstract: While a pharmacist may know of other medications approved by the FDA for the same medical condition, the pharmacist typically does not know what the therapeutically equivalent dose of those products is when compared to the originally prescribed item. In addition to this lack of equivalent dosage information, the pharmacist also is unable to determine if any of those other FDA approved items will save the consumer any money. Accordingly, embodiments of the invention can provide pharmacists and/or consumers with equivalent dosage information as well as pricing information for the equivalent dosage. Accordingly, based at least in part on this information, consumers may have an incentive to and may decide to purchase to another prescription drug, thereby shifting market share to a preferred prescription drug or pharmaceutical manufacturer or provider.

Abstract: Systems and methods are provided for retaining or shifting prescription market share. The systems and methods may include receiving, from a pharmacy computer, a prescription claim associated with a drug requested by a customer; determining that a payor will not cover the prescription claim; subsequent to determining that the payor will not cover the prescription claim, determining that eligibility requirements in accordance with a market share retention program have been satisfied in order to make the drug available for free to the customer; and transmitting, to the pharmacy computer, a notice of availability of the free drug for the customer.

Abstract: Systems and methods are provided for retaining or shifting prescription market share. The systems and methods may include receiving a claim from a pharmacy computer, where the claim is associated with a drug requested by a customer, routing the claim to an adjudication engine for benefits processing, and receiving, from the adjudication engine, coverage information for the claim, where the coverage information indicates an amount payable by the customer. The systems and methods may further include determining whether a discount or payment is available to reduce the amount payable by the customer, where the discount or payment is associated with funding by a pharmaceutical manufacturer. If the discount or payment is available, the systems and methods may include transmitting at least a notice of availability of the discount or payment to the pharmacy computer, or automatically adjudicating the claim back to the pharmacy with the reduced amount payable by the customer.

Abstract: Systems and methods are provided for retaining or shifting prescription market share. The systems and methods may include receiving a claim from a pharmacy computer, where the claim is associated with a drug requested by a customer, routing the claim to an adjudication engine for benefits processing, and receiving, from the adjudication engine, coverage information for the claim, where the coverage information indicates an amount payable by the customer. The systems and methods may further include determining whether a discount or payment is available to reduce the amount payable by the customer, where the discount or payment is associated with funding by a pharmaceutical manufacturer. If the discount or payment is available, the systems and methods may include transmitting at least a notice of availability of the discount or payment to the pharmacy computer, or automatically adjudicating the claim back to the pharmacy with the reduced amount payable by the customer.