US-20260128146-A1 - METHOD, APPARATUS, AND COMPUTER PROGRAM PRODUCT FOR PROVIDING REAL-TIME PRICING INFORMATION AND COMPILATION OF A STANDARDIZED MEASURE

US20260128146A1US 20260128146 A1US20260128146 A1US 20260128146A1US-20260128146-A1

Abstract

A method, apparatus and computer program product are provided for a compiled standardized measure representative of a subset of prescription transactions associated with a controlled substance. The compiled standardized measures may be used in the prescription domain to notify prescribers of a patient's morphine milligram equivalent (MME) to reduce risks related to drug overdose, abuse, and the like. Historical prescription transactions may be accessed to identify prescriptions classified as an opioid or other controlled substance, and that may likely still be in a patient's possession based upon days supply, such that a daily MME may be calculated. Messaging is provided to the prescriber if the amount exceeds a maximum threshold, and the prescription can be changed accordingly.

Inventors

Keith Crozier
Stacy McCrommon
Ashley Proctor

Assignees

MCKESSON CORPORATION

Dates

Publication Date: 20260507
Application Date: 20251219

Claims (20)

1 . An apparatus comprising one or more processors and at least one memory including computer program code that when executed by the one or more processors, causes the one or more processors to perform: storing, in a database, (a) a time threshold, (b) a history of prescription transactions comprising respective medications and cash prices, and (c) one or more maximum amounts per temporal unit of a medication associated with a predefined classification that a patient should take; receiving from a prescriber computer, a prescription inquiry associated with a patient, a pharmacy, and a medication; determining the medication is associated with the predefined classification; accessing, in the database, prescription transactions associated with the patient and the predefined classification, and the maximum amount per temporal unit of the medication associated with the predefined classification; determining, based on a days supply of the prescription transactions associated with the patient and the predefined classification, whether respective measures should be included in a compilation; generating a compiled standardized measure representative of a subset of prescription transactions associated with the patient and the predefined classification, by summing the standardized measures per the temporal unit for the prescription transactions; determining the compiled standardized measure exceeds the maximum amount and in response thereto, transmit to the prescriber computer, a response comprising the compiled standardized measure and an alert indicating the prescription would result in the maximum amount being exceeded; receiving a modified prescription inquiry from the prescriber computer; generating a prescription benefit coverage inquiry based on the modified prescription inquiry; transmitting the prescription benefit coverage inquiry to a pharmacy claims processor computer; monitoring a communication network for receipt of a prescription benefit coverage response associated with the prescription benefit coverage inquiry from the claims processor computer; determining whether a response from the pharmacy claims processor computer is received within the time threshold; based on a determination that the response from the pharmacy claims processor computer is received from the pharmacy claims processor computer within the time threshold, generating a prescription inquiry response comprising the response from the pharmacy claims processor computer; based on a determination that the response from the pharmacy claims processor computer is not received within the time threshold, and further based on the stored history of prescription transactions, generating the prescription inquiry response comprising a respective cash price response from the database; and transmitting the prescription inquiry response to the prescriber computer.
2 . The apparatus according to claim 1 , wherein the computer program code, when executed by the one of more processors, further causes the one or more processors to perform: precluding transmitting the prescription inquiry to the claims processor computer until the prescription inquiry is modified and resubmitted by the prescriber computer.
3 . The apparatus according to claim 1 , wherein the computer program code, when executed by the one of more processors, further causes the one or more processors to perform: executing a formulary alternative inquiry, wherein executing the formulary alternative inquiry comprises obtaining an alternative formulary response from the database; and transmitting the alternative formulary response to the prescriber computer.
4 . The apparatus according to claim 1 , wherein the predefined classification comprises a controlled substance classification.
5 . The apparatus according to claim 1 , wherein the temporal unit comprises a number of days.
6 . The apparatus according to claim 1 , wherein the maximum amount per temporal unit is determined based on at least one of a patient's age, a patient's gender, or a patient's weight.
7 . The apparatus according to claim 1 , wherein a number of days the compiled standardized measure is applicable is dependent on when one or more prescriptions associated with the prescription transactions is determined to be depleted.
8 . A computer program product comprising at least one non-transitory computer-readable storage medium having computer-executable program code instructions stored therein that when executed by one or more processors, cause the one or more processors to perform: storing, in a database, (a) a time threshold, (b) a history of prescription transactions comprising respective medications and cash prices, and (c) one or more maximum amounts per temporal unit of a medication associated with a predefined classification that a patient should take; receiving from a prescriber computer, a prescription inquiry associated with a patient, a pharmacy, and a medication; determining the medication is associated with the predefined classification; accessing, in the database, prescription transactions associated with the patient and the predefined classification, and the maximum amount per temporal unit of the medication associated with the predefined classification; determining, based on a days supply of the prescription transactions associated with the patient and the predefined classification, whether respective measures should be included in a compilation; generating a compiled standardized measure representative of a subset of prescription transactions associated with the patient and the predefined classification, by summing the standardized measures per the temporal unit for the prescription transactions; determining the compiled standardized measure exceeds the maximum amount and in response thereto, transmit to the prescriber computer, a response comprising the compiled standardized measure and an alert indicating the prescription would result in the maximum amount being exceeded; receiving a modified prescription inquiry from the prescriber computer; generating a prescription benefit coverage inquiry based on the modified prescription inquiry; transmitting the prescription benefit coverage inquiry to a pharmacy claims processor computer; monitoring a communication network for receipt of a prescription benefit coverage response associated with the prescription benefit coverage inquiry from the claims processor computer; determining whether a response from the pharmacy claims processor computer is received within the time threshold; based on a determination that the response from the pharmacy claims processor computer is received from the pharmacy claims processor computer within the time threshold, generating a prescription inquiry response comprising the response from the pharmacy claims processor computer; based on a determination that the response from the pharmacy claims processor computer is not received within the time threshold, and further based on the stored history of prescription transactions, generating the prescription inquiry response comprising a respective cash price from the database; and transmitting the prescription inquiry response to the prescriber computer.
9 . The computer program product according to claim 8 , wherein the computer-executable program code instructions, when executed by one or more processors, cause the one or more processors to perform: precluding transmitting the prescription inquiry to the claims processor computer until the prescription inquiry is modified and resubmitted by the prescriber computer.
10 . The computer program product according to claim 8 , wherein the computer-executable program code instructions, when executed by one or more processors, cause the one or more processors to perform: executing a formulary alternative inquiry, wherein executing the formulary alternative inquiry comprises obtaining an alternative formulary response from the database; and transmitting the alternative formulary response to the prescriber computer.
11 . The computer program product according to claim 8 , wherein the predefined classification comprises a controlled substance classification.
12 . The computer program product according to claim 8 , wherein the temporal unit comprises a number of days.
13 . The computer program product according to claim 8 , wherein the maximum amount per temporal unit is determined based on at least one of a patient's age, a patient's gender, or a patient's weight.
14 . The computer program product according to claim 8 , wherein a number of days the compiled standardized measure is applicable is dependent on when one or more prescriptions associated with the prescription transactions is determined to be depleted.
15 . A computer-implemented method comprising: storing, in a database, (a) a time threshold, (b) a history of prescription transactions comprising respective medications and prices, and (c) one or more maximum amounts per temporal unit of a medication associated with a predefined classification that a patient should take; receiving from a prescriber computer, a prescription inquiry associated with a patient, a pharmacy, and a medication; determining the medication is associated with the predefined classification; accessing, in the database, prescription transactions associated with the patient and the predefined classification, and the maximum amount per temporal unit of the medication associated with the predefined classification; determining, based on a days supply of the prescription transactions associated with the patient and the predefined classification, whether respective measures should be included in a compilation; generating a compiled standardized measure representative of a subset of prescription transactions associated with the patient and the predefined classification, by summing the standardized measures per the temporal unit for the prescription transactions; determining the compiled standardized measure exceeds the maximum amount and in response thereto, transmit to the prescriber computer, a response comprising the compiled standardized measure and an alert indicating the prescription would result in the maximum amount being exceeded; receiving a modified prescription inquiry from the prescriber computer; generating a prescription benefit coverage inquiry based on the modified prescription inquiry; transmitting the prescription benefit coverage inquiry to a pharmacy claims processor computer; monitoring a communication network for receipt of a prescription benefit coverage response associated with the prescription benefit coverage inquiry from the claims processor computer; determining whether a response from the pharmacy claims processor computer is received within the time threshold; based on a determination that the response from the pharmacy claims processor computer is received from the pharmacy claims processor computer within the time threshold, generating a prescription inquiry response comprising the response from the pharmacy claims processor computer; based on a determination that the response from the pharmacy claims processor computer is not received within the time threshold, and further based on the stored history of prescription transactions, generating the prescription inquiry response comprising a respective cash price from the database; and transmitting the prescription inquiry response to the prescriber computer.
16 . The computer-implemented method according to claim 15 , further comprising: precluding transmitting the prescription inquiry to the claims processor computer until the prescription inquiry is modified and resubmitted by the prescriber computer.
17 . The computer-implemented method according to claim 15 , further comprising: executing a formulary alternative inquiry, wherein executing the formulary alternative inquiry comprises obtaining an alternative formulary response from the database; and transmitting the alternative formulary response to the prescriber computer.
18 . The computer-implemented method according to claim 15 , wherein the predefined classification comprises a controlled substance classification.
19 . The computer-implemented method according to claim 15 , wherein the temporal unit comprises a number of days.
20 . The computer-implemented method according to claim 15 , wherein the maximum amount per temporal unit is determined based on at least one of a patient's age, a patient's gender, or a patient's weight.

Description

CROSS REFERENCES TO RELATED APPLICATIONS This application is a continuation-in-part of U.S. patent application Ser. No. 17/501,532 filed Oct. 14, 2021, which is a continuation-in-part of U.S. patent application Ser. No. 16/453,509, filed Jun. 26, 2019, the entire contents of which are hereby incorporated by reference in their entireties. This application is a continuation-in part of U.S. patent application Ser. No. 17/178,509, filed Feb. 18, 2021, the entire contents of which are hereby incorporated by reference in its entirety. TECHNOLOGICAL FIELD Embodiments of the present invention relate generally to healthcare transactions and inquiries, and more particularly, to methods, apparatuses, and computer program products for providing real-time pricing information and standardizing an electronic message component. BACKGROUND In the healthcare services industry, patients have difficulty finding pricing information for prescription drugs. In some instances, patients may not be aware of the cost of a prescription until they visit the pharmacy to purchase the prescription. As today's healthcare provider systems continue to evolve, so does the challenge in enabling the patient to understand their out-of-pocket cost. Still further, with developments in cash discount cards and/or systems, in some instances presenting a cash discount card rather than submitting a prescription benefit claim may result in a different cost for the same prescription drug. Additionally, alternative formularies may be available as suitable substitution for a medication, and may be available for a lower cost to the patient in comparison to a prescribed medication, through the benefit plan or a cash discount system. However, a patient typically does not have access to information regarding formulary alternatives and associated costs. Financial structures for prescription claims have become even more sophisticated over time (i.e. formulary tiers, deductibles, maximum benefits, etc.), and prices can vary greatly between pharmacies, making it even more difficult for patients to understand their prescription drugs costs. With the complexities of drug pricing, cash discount systems, insurance pricing agreements, and variation amongst pharmacies, patients particularly have difficulty understanding the costs of the prescriptions. Additionally, electronic messages pertaining to healthcare transactions are frequently originated, then transmitted and routed according to an identified recipient or destination in the message. A processing system may therefore route the message as directed, monitor a data feed or switch for a response, and forward or route the corresponding response message, once received, to the message originator or requesting computer. In some instances, many messages relating to a similar subject may be transmitted to and from disparate sources that may otherwise not be in direct communication with each other. In this regard, a requesting system may not have access to related messages, nor be able to interpret related messages, initiated by other requesting computers. In some instances, the information within the messages may be useful for some entities to access, but the entity may be unable to access the data due to the separation of information management infrastructure described above, and/or the data may not be in a format useful for the entity. BRIEF SUMMARY Methods, apparatuses, and computer program products are therefore provided for standardizing an electronic message component. Requesting computers, including those requesting prescription pricing information, may generate and transmit messages to a service provider computer that in turn routes the message to an evaluation system, such as a claims processor computer, for evaluation and return of a response to the service provider computer. The service provider computer may then forward the response to the requesting computer. The service provider computer may perform additional edits or manipulation of such messages and responses at various stages of the process, and may further store electronic messages, or historical electronic messages, for subsequent access and/or retrieval. According to example embodiments provide herein, when the service provider computer receives a prescription inquiry as an electronic message, the service provider computer may access related prescription transactions, such as based on an entity identifier and/or predefined classification of a product identifier (e.g., prescribed medication) identified in the prescription inquiry and the historical transactions. The service provider computer may then process each of the historical transactions to standardize a component of the messages, and compile the standardized data to provide in response to the subject electronic message. According to certain example embodiments, a prescriber, such as a physician or other medical practitioner may write a prescription for a patient. In some instances, a prescriber