Abstract: A decision tree processing system comprises non-transitory data storage configured to store a target data stream and a hardware processor in communication with the non-transitory data storage. The hardware processor can be programmed to access the target data stream, apply a decision tree to at least a portion of the target data stream, and generate a predicted outcome based at least partly on the applied decision tree. The decision tree can comprise a question set that is applied to the target data stream to generate a set of answers that are used at least partly to generate the predicted outcome. In various implementations, the decision tree processing system can be applied to geographic information services, prescription medication prior authorizations, or the Internet of Things.

Abstract: Provided is a method and apparatus for preparing a request for prior authorization of coverage for a prescription drug. After a previous claim requesting at least partial coverage of a cost associated with the prescription drug has been submitted, a notification that prior authorization of the at least partial coverage has been required by the benefits manager is received. After receiving this notification, the method involves automatically conducting a query of a computer-accessible database to retrieve information included in a previously-submitted request for prior authorization. The information retrieved is presented to be confirmed as suitable for submission in the request for prior authorization as part of a current transaction and, in response to receiving confirmation that the information presented is suitable for submission as part of the request for prior authorization during the current transaction, transmitted to at least one of a prescriber for approval and the benefits manager.

Abstract: An apparatus, a method, and a computer program product are provided. The apparatus includes at least one memory including computer program code, and at least one processor. The at least one memory and the computer program code are configured to, with the at least one processor, cause the apparatus at least to receive a request to generate a prior authorization form for a prescription drug, and select the prior authorization form from a plurality of prior authorization forms based on the request. The prior authorization form is selected based on at least one of a user search result and a standardized transaction. The at least one memory and the computer program code are further configured to, with the at least one processor, cause the apparatus at least to transmit the selected prior authorization form to a user so that the user can complete and submit the prior authorization form to the health plan and receive a determination on the request.

Abstract: Provided is a method of processing a request pertaining to a prescription drug. The method includes receiving, with a computer system after a claim requesting at least partial insurance coverage of a cost associated with the prescription drug has been submitted to an insurance benefits manager, a notification that prior authorization has been required. Before the request for prior authorization is submitted, it is determined that an alternate drug is a possible substitute for the prescription drug, and the alternate drug is believed to not require prior authorization under the insurance policy. The determination is made based on data contained in a database that is generally accepted in a pharmacy industry and is not unique to an insurer affiliated with the insurance policy.

Abstract: Provided is a method and system for facilitating limited fulfillment of a prescription for a drug. An indication that an authorizing party has rejected an insurance claim submitted by a pharmacy for insurance coverage of at least a portion of a purchase price of a prescription drug on behalf of a patient is received over a network, in addition to an indication that prior authorization is required. Before a decision whether to grant the prior authorization is issued by the authorizing party, initiating transmission of an offer to allow redemption of a quick start voucher to the pharmacy over the communication network that allows the limited fulfillment of the prescription for the prescription drug, but less than the complete fulfillment.

Abstract: An apparatus, a method, and a computer program product are provided. The apparatus includes at least one memory including computer program code, and at least one processor. The at least one memory and the computer program code are configured to, with the at least one processor, cause the apparatus at least to receive a request to generate a prior authorization form for a prescription drug, select the prior authorization form from a plurality of prior authorization forms based on the request, and transmit the selected prior authorization form to a user so that the user can complete and submit the prior authorization form to the health plan and receive a determination on the request. The prior authorization form is selected based on at least one of a user search result and a standardized transaction.

Abstract: An apparatus, a method, and a computer program product are provided. The apparatus includes at least one memory including computer program code, and at least one processor. The at least one memory and the computer program code are configured to, with the at least one processor, cause the apparatus at least to receive a request to generate a prior authorization form for a prescription drug, and select the prior authorization form from a plurality of prior authorization forms based on the request. The prior authorization form is selected based on at least one of a user search result and a standardized transaction. The at least one memory and the computer program code are further configured to, with the at least one processor, cause the apparatus at least to transmit the selected prior authorization form to a user so that the user can complete and submit the prior authorization form to the health plan and receive a determination on the request.