System And Method For Managing Selection Of Prescription Drug Plans
a system and drug technology, applied in the field of prescription drug plans, can solve the problems of not being able to accurately represent the value of the bid, not being able to calculate the cost of any one rfp bid, much less, and not being able to provide maximum savings to clients and patients in a reasonable period of tim
Pending Publication Date: 2021-02-18
TRUVERIS INC
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AI Technical Summary
Benefits of technology
This system enables plan sponsors to objectively evaluate and compare bids, leading to more informed decision-making and enhanced cost savings by standardizing bid assessments and projecting costs accurately across RFP submissions.
Problems solved by technology
A problem that arises with current implementations of RFPs is that plan sponsors (business entities, corporations, etc. with health- and medical-insurable employees) are reliant upon the cost projections provided by the PBM vendors, which often do not fairly or accurately represent the value of the bids being presented.
Due to the complexities associated with the pharmacy benefit industry and pricing methodologies for prescription drugs, evaluation of PBM bids are typically subject to the calculations or stated cost projections provided by the vendors themselves.
Absent the aforementioned elements, calculating the costs of any one RFP bid, much less a multitude of bids typically submitted by various PBM vendors in the course of an RFP process, can not be done in a reasonable period of time to provide maximum savings to clients and patients.
Furthermore, due to the interpretive nature of contract language, PBM bid contract terms may be manipulated through subtlety in language and nuance in terminology, which cannot be fairly assessed to compare vendor RFP submissions.
As a result, RFP submissions are highly subjective and prone to manipulation by PBM vendors and bids cannot be fairly or objectively assessed by even the most knowledgeable industry professionals and data analysts due to the unmanageably large claims data sets, complex calculations involving determinations of drug classification and application of pricing terms, reliance upon costly subscription services for third party data elements, and variety of terms and pricing proposals provided in the limited period of time allowed to complete an RFP process.
Method used
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[0025]Embodiments of the invention provide methods for managing selection of prescription drug plans.
[0026]In the following description, numerous details are set forth. It will be apparent, however, to one skilled in the art, that the present invention may be practiced without these specific details. In some instances, well-known structures and devices are shown in block diagram form, rather than in detail, in order to avoid obscuring the present invention.
[0027]Some portions of the detailed descriptions are presented in terms of algorithms and symbolic representations of operations on data bits within a computer memory. These algorithmic descriptions and representations are the means used by those skilled in the data processing arts to most effectively convey the substance of their work to others skilled in the art. An algorithm is here, and generally, conceived to be a self-consistent sequence of steps leading to a desired result. The steps are those requiring physical manipulatio...
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A system and method for managing selection of a prescription drug plan, based on generating a request for proposal (RFP), submitting the RFP to prescription benefit management (PBM) vendors, receiving bids from PBM vendors, and calculating weighted scores of the bids to determine total score for the plan.
Description
CROSS REFERENCE TO RELATED APPLICATION[0001]This application is a continuation of and claims priority to U.S. patent application Ser. No. 13 / 999,121 filed Jan. 16, 2014, entitled “System And Method For Managing Selection Of Prescription Drug Plans,” now U.S. Pat. No. 10,817,920, which claims the benefit under 35 U.S.C. 119(e) of U.S. Patent Application No. 61 / 753,530, filed Jan. 17, 2013, which are hereby incorporated by reference herein in their entirety.FIELD OF THE INVENTION[0002]Embodiments of the invention relate generally to prescription drug plans and, more specifically, to electronic management of a request for proposal (RFP) and corresponding bids for selecting a prescription drug plan.BACKGROUND OF THE INVENTION[0003]Presently, sponsors of pharmacy benefit management plans typically enter into a request for proposal (“RFP”) process every few years in order to maintain market competitive benefits, which may be valued at $5 Million to $500 Million in plan spend per year. Thi...
Claims
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IPC IPC(8): G06Q30/06G16H40/20G16H50/70G16H20/00G06Q10/10G06Q40/08G06Q50/22
CPCG06Q30/0611G16H40/20G16H50/70G06Q50/22G06Q10/10G06Q40/08G16H20/00
InventorBEGLEY, KRISTINGREENE, LEONLOIACONO, ANTHONY J.STALOCH, TOM
OwnerTRUVERIS INC