PROVIDING DRUG AND MEDICAL PRICING INFORMATION

FIELD OF THE INVENTION This invention relates to methods for searching and comparing prices for medications and medical products and services, and more particularly, a system and method for determining a lowest payment method and/or combination of payment methods for purchasing one or more medical products, such as drug prescriptions, wherein a lowest out- of-pocket expense to a patient is determined based on various pricing and reimbursement variables; or one or more medical services, such as an outpatient medical procedure, wherein a lowest out-of-pocket expense to a patient is determined based on various pricing variables and reimbursement variables.

BACKGROUND OF THE INVENTION

Conventional methods for gathering and reporting prices relating to medical products or services are based on conventional aggregating and reporting methods. For example, conventional pharmaceutical pricing aggregators operate by obtaining drug pricing information from one or more pharmacy benefit managers (“PBM”), which is then simply passed on to patients looking for a lowest offered “cash” price. For example, a conventional system may obtain, calculate, and/or estimate drug prices that are available under contracts or agreements between PBMs and various pharmacies, which is information typically not available to average consumers. In response to a request for a price of a specific drug, conventional systems will display relevant prices paid directly by the patient for each pharmacy chain and/or display prices found in a particular geographic area. The users can compare prices for a particular drug and determine which pharmacy they prefer to purchase the drug from. Conventional dmg pricing methods concentrate on a lowest direct price and, however, the cheapest direct price of a prescription may not equate to the lowest out-of- pocket expense for a patient. Conventional systems fail to take many factors and variables, including insurance coverage into account that affect the amount a patient pays out-of- pocket at the register. For example, a conventional drug pricing method may find a cheapest price for a prescription but a higher price at another pharmacy may be a better deal for a patient based on the patient’s insurance, co-pays, reimbursement sources and other variables. Without additional information and analysis, the patient mistakenly ends up purchasing a prescription for a price they believe is saving the most money, when the purchased prescription is actually costing them more. The same holds true for medical services provided by doctors, dentists, veterinarians and others wherein pricing and reimbursement plans are commonly withheld from the general public.

Therefore, a need exists for a system and method for determining a lowest payment method and/or combination of payment methods for purchasing one or more medicines, medical products or medical services wherein a lowest out-of-pocket expense to a patient is determined based on various pricing variable and reimbursement variables.

SUMMARY OF THE INVENTION The primary object of the present invention is to provide a system and method for determining a lowest payment method and/or combination of payment methods for purchasing one or more medicines, medical products or medical services wherein a lowest out-of-pocket expense to a patient is determined based on various pricing variable and reimbursement variables. The present invention fulfills the above and other objects by providing a system for determining a best purchase method wherein a combination of pricing variables and/or reimbursement variables are examined, such as cash, insurance reimbursement, purchasing a generic version vs. a name brand version, quantity of the prescription, pharmacy benefit managers’ (PBM) pricing information, manufacturers’ coupons, geographic location of a patient/purchaser, and so forth, and to determine how each pricing variable and/or insurance reimbursement variable work together or independently to offset a price of a desired medical product or medical service for a patient. By accessing data through private and public databases, the system and method of the present invention capable of comparing and contrasting a plurality of variables to determine the lowest out of pocket scenario for that specific patient.

An additional element of the present invention also compromises a reminder system for patients to refill their medications. This includes the inclusion of the users’ specific medication, dose, and prescription timelines. Reminders preferably include a coupon for a pharmacy refilling the prescription confirming the purchase method providing the lowest- out-of-pocket purchase method and/or a coupon for a new pharmacy if a lower purchase method is determined at a new pharmacy prior to a date for re-filling the prescription.

The reminder system may also be used to send or push reminder notifications reminding a patient or customer to schedule an appointment or of a previously scheduled appointment at a medical provider, such as a doctor, dentist, veterinarian, and so forth.

The system and method of the present invention may be used to aggregate and present quality ratings, reviews, complaints, and so forth to present to a user in addition to pricing information so a user may make as an informed decision as possible regarding the medical service or medical product being purchased.

The above and other objects, features and advantages of the present invention should become even more readily apparent to those skilled in the art upon a reading of the following detailed description in conjunction with the drawings wherein there is shown and described illustrative embodiments of the invention. BRIEF DESCRIPTION OF THE DRAWINGS

In the following detailed description, reference will be made to the attached drawings in which:

FIG. 1 is a schematic diagram showing an online environment in which the system and method of the present invention operates;

FIG. 2 is a flow chart showing steps for carrying out the system and method of the present invention wherein steps for determining a lowest out of pocket cost for a patient are illustrated; and

FIG. 3 is a flow chart showing steps for carrying out the system and method of the present invention wherein steps for monitoring a user ’ s user of a specific drug are illustrated.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

With reference to FIG. 1, an example data flow diagram for providing medical pricing information for medical services and/or medical products from multiple data providers to a user interface is illustrated. The method and system of the present invention is accessed online via a user interface 101 that is presented on an online site accessed using an electronic device capable of accessing a software application of the present invention through a provider network 102 having online access to a plurality of data providers 103.

A user, such as a patient or retail purchaser of a prescription drug, may access the provider network 102 over the Internet or app and user interface presented on the user’s electronic device, which may be any suitable computing device, such as a smart phone, a tablet, a laptop, and so forth. The provider network 102 comprises at least one database 104, connected to a medical price management system 105 or module and an adjudication system 106 or module. The information obtained, analyzed, and stored within the provider network 102 is obtained from third party data providers 103, which may comprise medical providers, doctors, physician assistants, dentists, specialists, veterinarians, drug manufacturers, formulary data, PBMs, pharmacies, health insurance providers, government entities, Medicaid, Medicare, and so forth. The information obtained, analyzed, and stored within the provider network 102 comprises pricing variables and reimbursement variables provided by the data providers 103. Pricing and reimbursement variables may comprise variables relating to a medical provider’s published fees, PBM data, geographic location, price lists, cash payments, insurance reimbursement, purchasing a generic version vs. a name brand version, quantity of a prescription, manufacturers’ coupons, geographic location of patient and so forth.

With reference to FIG. 2, a flow chart showing steps for carrying out the system and method of the present invention wherein steps for determining a lowest out of pocket cost for a patient is illustrated. First, a graphical user interface is presented on a user’s electronic device 201 that provides the user with access to an online site capable of accessing a software application of the present invention through a provider network having online access to a plurality of third-party data providers, as illustrated in FIG. 1. A user may be a patient, a parent or guardian of a patient, a caregiver or any individual purchasing medical services and/or medical products. The graphical user interface provides capability for a user to enter information relating to a medical service and/or medical product, such as a prescribed drug the user wishes to search after which, a lowest out-of-pocket price for the user based on a plurality of variables provided by the user and third-party data providers. Third party data providers may comprise medical providers, drug manufacturers, formulary data, PBMs, pharmacies, health insurance providers, government entities and so forth, that provide data relating to pricing and reimbursement variables, may include variables relating to PBM data, geographic location, cash, insurance reimbursement, purchasing a generic version vs. a name brand version, quantity of the prescription, manufacturers’ coupons, location of patient and so forth.

Next, a geographical location of the user is determined using location services on the user’s electronic device or from the user manually entering his or her location into the graphical user interface 202. Then, the user may search for one or more medical services and/or medical products using the graphical user interface 203. Next, the determined location is used to locate medical service providers and/or medical product providers, such as retail pharmacies, within a specified distance from the user’s determined location and customary prices for searches of medical services and/or medical products are obtained 204.

Then, availability of discount pricing is determined at the located medical service providers and/or medical product providers 205. This may also comprise determining available savings programs in the specified geographic area and eligibility requirements for any savings programs. Next, any insurance coverage for the medical service and/or medical product is determined 206 and a real-time level of coverage and copay pricing is provided to the user via the graphical interface 207. Then, availability of any savings programs relating to the user’s determined co-pay is determined and provided to the user 208. Next, the lowest cost method for the user within each determined variable is determined 209. Finally, the lowest cost method for the user is presented on a coupon or voucher via the graphical interface 210.

Finally, with reference to FIG. 3, a flow chart showing steps for carrying out the system and method of the present invention wherein steps for monitoring a user’s user of a specific drug is illustrated. First, the lowest cost method for the user is presented on a coupon or voucher via the graphical interface 301, as described in FIG. 2. Then, the user is provided with capability to print, email or text the coupon or voucher 302.

Next, the user is provided with capability to select reminders for administering the drug 303 to be delivered via the service provider network illustrated in FIG. 1. The user is then provided with subsequent reminders to take required doses at specified times. Next, the user confirms if he or she took the required dose using the graphical interface 304. Then, the user is sent a message confirming compliance or non-compliance 305.

The user may also be provided with capability to select reminders for refiling the prescription 306. Future reminders are delivered to the user via the service provider network with a coupon or voucher for the drug to be re-filled 307.

Prescription reminders may comprise inclusion of a user’s specific medication, dose, and prescription timelines. Reminders preferably include a coupon for a pharmacy refilling the prescription confirming the purchase method and thus, the lowest-out-of-pocket purchase method for the patient and/or a coupon for a new pharmacy if a lower purchase method is determined at a new pharmacy prior to a date for re-filling the prescription.

In addition, the user may be provided with capability to select reminders for future medical services, such as follow/up appointments, procedure dates, and so forth 308. Future reminders may be delivered to the user via the service provider network with a coupon or voucher for the medical service 309 and/or a real time out of pocket cost for the service.

The user may also be provided with real time deductible tracking to allow a user to determine when one or more deductibles have been met 310. Future reminders may be delivered to the user via the service provider network with expiration reminders for any met deductibles 311. The user’s benefits may be tracked, searched, aggregated and analyzed by organization and/or group health plan.

It is to be understood that while a preferred embodiment of the invention is illustrated, it is not to be limited to the specific form or arrangement of parts herein described and shown. It will be apparent to those skilled in the art that various changes may be made without departing from the scope of the invention and the invention is not to be considered limited to what is shown and described in the specification and drawings.