Abstract: A system and method for monitoring patient adherence to prescribed medications include a processor that analyzes prior authorization data and insurance claims data based on adherence rules, which are user configurable. The system assigns non-adherence cases for user review by creating work queues. Queues may be associated with respective user roles. In response to a non-adherence case, the system generates automated notifications using a notification template. Placeholder variables are insertable into the templates to describe a parameter applicable to a specific instance of non-adherence. The placeholder is replaced by an actual value of the parameter when a notification document is subsequently generated.

Abstract: A system and method for requesting prior authorization for a medical product and/or service includes a processor providing a user interface accessible over a network and via which to receive user input of information concerning the product and/or service, the intended recipient thereof, and the prescriber thereof. The user interface is accessible using each of a plurality of user profiles, including two or more of the prescriber, user, and provider. Login information is not required for the request generation, a recipient health plan identification being used instead. Different sequences are provided by the processor depending on the user profile used for generating the request. Request status is provided based on input of a code generated for the request and without requiring login information. The system is configured to generate and transmit to the prescriber a communication regarding the request where the request is initiated using a recipient profile.