Direct drug management of benefits system by insurer, information-processing device, information-processing method, and program

Abstract

To provide a direct medicine management of benefits system by an insurer for reducing costs relating to the provision of prescribed medicines.SOLUTION: Information related to a prescribed drug included in a medical fee statement is acquired for each of a plurality of prescribed drugs. Statistical information of prescription contents for each of a plurality of prescribed drugs calculated based on information related to the prescribed drugs is acquired. To estimate the kind and quantity of prescribed medicines to be collectively purchased by analyzing prescription contents.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present disclosure relates to a system for managing direct drug delivery by an insurer, an information processing device, an information processing method, and a program. [Background technology]

[0002] Patent document 1 discloses an order management system that creates an operating organization for a joint purchasing system for medicines, etc., and virtually centrally handles the inventory of medicines, etc. at multiple dispersed medical institutions, dispensing pharmacies, etc., thereby allowing the purchase of medicines, etc., which has previously been done individually by each medical institution and pharmacy, to be jointly and centrally handled. [Prior art documents] [Patent documents]

[0003] [Patent Document 1] Japanese Patent Application Laid-Open No. 2003-246455 Summary of the Invention [Problem to be solved by the invention]

[0004] In the above-mentioned technology, there is a need for a technology that can reduce the costs associated with providing prescription drugs.

[0005] An object of the present disclosure is to provide an insurer's direct drug delivery management system, an information processing device, an information processing method, and a program that solve the above-mentioned problems. [Means for solving the problem]

[0006] An insurer's direct drug benefit management system according to one embodiment of the present disclosure includes a prescription information acquisition means for acquiring information related to prescription drugs included in a medical fee statement for each of a plurality of prescription drugs, a prescription content acquisition means for acquiring statistical information on the prescription content for each of the plurality of prescription drugs calculated based on the information related to the prescription drugs, and a purchase information estimation means for analyzing the prescription content and estimating the type and quantity of prescription drugs to be purchased in bulk.

[0007] An information processing device according to one aspect of the present disclosure includes a prescription information acquisition means for acquiring information related to prescription drugs included in a medical fee statement for each of a plurality of prescription drugs, a prescription content acquisition means for acquiring statistical information on the prescription content for each of the plurality of prescription drugs calculated based on the information related to the prescription drugs, and a purchase information estimation means for analyzing the prescription content and estimating the type and quantity of prescription drugs to be purchased in bulk.

[0008] An information processing method according to one aspect of the present disclosure obtains information related to prescription drugs included in a medical fee statement for each of a plurality of prescription drugs, obtains statistical information on the prescription contents for each of the plurality of prescription drugs calculated based on the information related to the prescription drugs, and analyzes the prescription contents to estimate the type and quantity of prescription drugs to be purchased in bulk.

[0009] A program according to one aspect of the present disclosure causes a computer to function as a prescription information acquisition means for acquiring information related to prescription drugs included in a medical fee statement for each of a plurality of prescription drugs, a prescription content acquisition means for acquiring statistical information on the prescription content for each of the plurality of prescription drugs calculated based on the information related to the prescription drugs, and a purchase information estimation means for analyzing the prescription content and estimating the type and quantity of prescription drugs to be purchased in bulk. [Effects of the Invention]

[0010] According to the above aspect, it is possible to reduce the cost of providing prescription drugs. [Brief explanation of the drawings]

[0011] [Figure 1] FIG. 1 illustrates the relationship of objects involved in a medication distribution system according to one aspect of the present disclosure. [Figure 2] 1 is a diagram showing the system configuration of a drug distribution system according to one embodiment of the present disclosure. [Figure 3] FIG. 2 is a diagram illustrating a hardware configuration of a management device according to an aspect of the present disclosure. [Figure 4] FIG. 2 is a functional block diagram of a management device according to an aspect of the present disclosure. [Figure 5] FIG. 10 is a diagram illustrating an example of a database included in a management device according to an aspect of the present disclosure. [Figure 6] FIG. 10 is a diagram illustrating a processing flow of a management device according to an aspect of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0012] Under Japan's health insurance system, insurers are required to provide insurance benefits in the form of "medical treatment," and pharmaceuticals are provided to insured persons as medical treatment in kind at medical institutions or pharmacies based on prescriptions from doctors in charge of medical treatment.

[0013] This legal structure is based on a predetermined "delegation" from the insurer to the medical provider, and until now, the insurer has not been directly involved in selecting the drugs to be provided.

[0014] In Japan, doctors have strong prescribing rights regarding which medications should be prescribed to each insured person based on their condition, and insurers have no room to decide this. However, if a drug of the same type has been prescribed, insurers can decide which pharmaceutical company's product to cover without infringing on the doctor's prescribing rights.

[0015] If this is the case, it makes perfect sense for insurers to decide for themselves which products are most economically rational for health and provide them to insured persons.

[0016] From this perspective, until now in Japan, there has been no concept of insurers themselves managing drug benefits based on accurate benefit data (medical fee statements), and therefore no system for doing so has been devised.

[0017] Under Japan's health insurance system, medical personnel are required to bill the insurer each month for the costs incurred in providing medical care, along with a detailed statement of the costs, and the insurer has access to extremely detailed data on monthly drug payments.

[0018] This data can be used to clarify which medications are paid out to which insured persons each month, and by doing so, it is possible to identify which medications will be prescribed and paid out in the future. From among multiple medications with the same efficacy, the insurer can select the most economically rational medication that is most suitable for payment and then purchase it all at once, thereby optimizing the costs associated with benefits.

[0019] One of the problems this disclosure aims to solve is "which drugs should insurers themselves select as coverage targets to enable the most appropriate drug coverage?" To achieve this, we provide a system that analyzes medical fee statement data to determine which drugs will be covered, as well as a system for directly purchasing those drugs, a system for determining which pharmacies will be covered and distributing the drugs to those pharmacies, and a system that can provide data related to appropriate guidance when pharmacies provide drug coverage to insured persons.

[0020] Hereinafter, the information processing device of the present disclosure will be described with reference to the drawings. FIG. 1 is a diagram showing the relationships between entities related to a direct pharmaceutical benefit management system by an insurer according to one embodiment of the present disclosure. Entities related to a direct pharmaceutical benefit management system 100 including an information processing device according to the present disclosure include an insurer 1, an insured person 2, a medical institution 3, a dispensing pharmacy 4, a pharmaceutical company 5, and the like. The insurer 1 is, for example, defined under the Japanese health insurance system as an entity that conducts health insurance business, such as a health insurance association. The insured person 2 is defined under the Japanese health insurance system as a person who is enrolled in health insurance. The medical institution 3 provides medical care to the insured person 2, and the dispensing pharmacy 4 receives from the insured person 2 a prescription prescribed by a doctor and dispenses medicine, etc. The pharmaceutical company 5 is a company or the like that manufactures, sells, etc. prescription drugs, etc. used at the dispensing pharmacy 4.

[0021] Insured person 2 receives medical treatment at medical institution 3. Medical institution 3 hands over a prescription to insured person 2, who is a patient. Insured person 2 hands over the prescription to dispensing pharmacy 4, etc. Dispensing pharmacy 4 dispenses the medicine and receives a co-payment from the patient. Dispensing pharmacy 4 submits a dispensing fee claim to insurer 1. Medical institution 3 sends medical fee statement data (received data) to insurer 1. The medical fee statement and dispensing fee claim are collectively referred to as the "medical and dispensing fee claim statement."

[0022] The insurer 1 then manages prescription drugs using the direct drug benefit management system 100 disclosed herein. Specifically, the insurer 1 uses the direct drug benefit management system 100 to submit bids for drug purchases to pharmaceutical companies 5, and places orders for, purchases, and pays for prescription drugs from the bidding pharmaceutical companies 5. The insurer 1 also manages the allocation and inventory of purchased drugs. The drugs purchased by the insurer 1 may be delivered to the insurer 1 and distributed by the insurer 1, or may be delivered to a designated supplier and distributed by the supplier to each dispensing pharmacy 4 as instructed by the insurer 1. The insurer 1 may provide information regarding the prescription of the insured person 2. The dispensing pharmacy 4 may provide medication instructions, etc. based on the information regarding the prescription of the insured person 2 provided by the insurance company.

[0023] FIG. 2 is a diagram illustrating the system configuration of a direct pharmaceutical delivery management system according to one embodiment of the present disclosure. The direct drug benefit management system 100 shown in FIG. 2 is configured to include, as an example, a management device 10, an insurer server 20, a medical institution server 30, a pharmacy terminal 40, a pharmaceutical company terminal 50, and a supplier terminal 60. The direct drug benefit management system 100 may include at least the management device 10. The management device 10 may be a computer managed by the insurer 1 or an information processing company or the like commissioned by the insurer 1. The insurer server 20 may be managed by the insurer 1. The medical institution server 30 may be managed by the medical institution 3. The pharmacy terminal 40 may be managed by the dispensing pharmacy 4. The pharmaceutical company terminal 50 may be managed by the pharmaceutical company 5. The supplier terminal 60 may be managed by the supplier. The management device 10 is an example of an information processing device disclosed herein.

[0024] FIG. 3 is a diagram illustrating a hardware configuration of a management device according to an embodiment of the present disclosure. 3, the management device 10 is a computer equipped with the following hardware: a CPU (Central Processing Unit) 101, a ROM (Read Only Memory) 102, a RAM (Random Access Memory) 103, a storage device 104, a communication module 105, an input device 106, and a monitor 107. The management device 10 may be equipped with other hardware such as a GPU instead of the CPU 101. The insurer server 20, the medical institution server 30, the pharmacy terminal 40, the pharmaceutical company terminal 50, and the supplier terminal 60 are also computers equipped with similar hardware.

[0025] FIG. 4 is a functional block diagram of a management device according to one embodiment of the present disclosure. The management device 10 executes a medicine distribution management program, thereby enabling the management device 10 to perform the functions of a control unit 11, a prescription information acquisition unit 12, a prescription content calculation unit 13, a database generation unit 14, a prescription content acquisition unit 15, a purchase information estimation unit 16, a pharmaceutical company management unit 17, a pharmacy management unit 18, and a guidance information generation unit 19.

[0026] The control unit 11 controls the management device 10 . The prescription information acquisition unit 12 acquires information relating to the prescribed drugs included in the medical fee statement for each of the plurality of prescribed drugs. The prescription content calculation unit 13 calculates statistical information on the prescription content for each of a plurality of prescribed drugs based on information related to the prescribed drugs. The database generating unit 14 generates a database using information such as statistical information on the prescription contents for each prescribed drug. The prescription content acquisition unit 15 acquires statistical information on the prescription content for each of a plurality of prescribed medicines. The purchase information estimation unit 16 analyzes the prescription contents and estimates the type and amount of the prescribed medicine to be purchased in bulk. The pharmaceutical company management department 17 processes information relating to operations such as bidding, ordering, purchasing, payment, and delivery of prescription drugs that are the subject of bulk purchase. The pharmacy management unit 18 manages the distribution of prescription drugs that are purchased in bulk and the provision of information about the insured person 2 to the dispensing pharmacy 4. The instruction information generating unit 19 generates instruction information.

[0027] The management device 10 of the present disclosure acquires prescription drug-related information for each of a plurality of prescription drugs included in a medical fee statement, and analyzes the prescription content based on statistical information on the prescription content for each of the plurality of prescription drugs calculated based on the prescription drug-related information, and estimates the type and amount of prescription drugs to be purchased in bulk. This allows the insurer 1 to identify drugs prescribed in large quantities, purchase those drugs in bulk, and manage the allocation of drugs to each dispensing pharmacy 4, thereby reducing the costs related to prescription drugs prescribed to insured persons 2 and reducing the financial burden on the government, insured persons 2, etc. related to medical care.

[0028] FIG. 5 is a diagram illustrating an example of a database included in a management device according to an embodiment of the present disclosure. First, the management device 10 generates various databases based on medical fee statement data (hereinafter referred to as receipt data). The databases stored in the management device 10 of the present disclosure include an insurer total receipt DB 51, an insurer dispensing receipt DB (DataBase) 52, a first prescription content DB 53 for each insured person 2, a second prescription content DB 54 for each dispensing pharmacy 4, and a third prescription content DB 55 for each drug unit.

[0029] The insurer all receipts DB 51 stores all receipt data of the insured person 2 who is enrolled in the health insurance business of the insurer 1. The insurer dispensing receipt DB 52 stores information included in receipt data issued during a unit period and the identifier of the dispensing pharmacy 4 that dispensed the prescription based on the receipt data. The first prescription content DB 53 stores prescription contents (type and amount of prescribed medicine) for each insured person 2 prescribed in a unit period. The second prescription content DB 54 stores the prescription content (type and amount of prescribed drug) of each of the prescribed drugs prescribed by the plurality of dispensing pharmacies 4 in a unit period. The third prescription content DB 55 stores prescription content (type and amount of prescribed drug) for each drug unit prescribed in a unit period.

[0030] FIG. 6 is a diagram illustrating a processing flow of the management device according to one embodiment of the present disclosure. The receipt data sent by the medical institution server 30 is linked to information included in the dispensing fee claim sent by the pharmacy terminal 40 (such as the identifier of the dispensing pharmacy 4), and is stored in advance in the insurer server 20. The data stored in the insurer server 20 may be the medical / dispensing fee claim statement described above. The prescription information acquisition unit 12 of the management device 10 acquires the receipt data stored in the insurer server 20 and stores it in the insurer total receipt DB 51.

[0031] The prescription information acquisition unit 12 of the management device 10 reads the prescription data stored in the insurer all-receipt DB 51 and the identifier of the dispensing pharmacy 4 that dispensed the medication based on the prescription data linked to the prescription data (step S101). The prescription information acquisition unit 12 outputs the acquired prescription data and the identifier of the dispensing pharmacy 4 that dispensed the medication to the database generation unit 14. The database generation unit 14 identifies prescription data stored in the insurer server 20 that includes the dates of each day of the unit period as the issue date, etc. The unit period may be, for example, one month from the previous month. Alternatively, the unit period may be three months from one month ago, two months ago, or three months ago. Alternatively, the unit period may be six months or one year. The database generation unit 14 extracts information about prescription drugs (such as the type of prescription drug and the prescribed amount) from the information included in the acquired prescription data, and generates an insurer dispensing receipt DB 52 that stores prescription details about the prescription drugs (the type of prescription drug and the prescribed amount described in each receipt data) linked to the identifier of the insured person 2, the identifier of the dispensing pharmacy 4 that dispensed the drug, the identifier of the unit period, etc. (Step S102). The insurer dispensing receipt DB 52 may store information other than the identifier of the insured person 2, the identifier of the dispensing pharmacy 4 that dispensed the drug, and the identifier of the unit period, extracted from the prescription data. The database generation unit 14 writes the insurer dispensing receipt DB 52 to the storage device 104. The storage device 104 may be configured with a RAID or the like. The database generation unit 14 repeats the same process, adding information for each unit period to the insurer dispensing receipt DB 52.

[0032] Based on the information recorded in the generated insurer dispensing receipt DB 52, the database generation unit 14 generates a first prescription content DB 53 storing prescription details (type and amount of prescribed drug) prescribed for each insured person 2 during a unit period (step S103). Specifically, the database generation unit 14 reads prescription details linked to the identifier of one insured person 2 from the insurer dispensing receipt DB 52, calculates the amount of each type of prescribed drug included in the prescription details, and generates the first prescription content DB 53 by linking the identifier of the insured person 2, the type of prescribed drug, and the amount of prescribed drug. The database generation unit 14 may output a prescription amount calculation instruction to the prescription content calculation unit 13. The prescription content calculation unit 13 calculates the prescription amount based on information regarding the prescription amount included in the receipt data, and outputs the prescription amount to the database generation unit 14. The prescription amount is an example of statistical information for the unit period. For example, if the unit period is one month, the amount of drug prescribed and dispensed per month (prescription amount) can be calculated by multiplying the value of the single dose written on one prescription x the number of doses per day x the number of prescription days by the number of prescriptions per unit period (e.g., one month).

[0033] The type of prescription drug may be a type represented by the brand name by strength, or the generic name of the prescription drug and its strength. The amount of prescription drug may be the total strength prescribed for the type indicated by the prescription drug in a unit period. The storage device 104 pre-stores a drug master DB 50 indicating the relationship between original drugs and generic drugs (generic drugs) that contain the same active ingredients as the original drug in the same amount and have the same efficacy and effects. The database generation unit 14 may generate a first prescription content DB 53 by identifying multiple prescription drug types that have a relationship between an original drug and a generic drug as the same type based on the prescription drug type and the relationship between the original drug and the generic drug recorded in the master DB. In this case, the prescription drug types of the original drug and the generic drug corresponding to the original drug may be included in the first prescription content DB 53 as the same type. The database generation unit 14 determines whether processing has been performed for all insured persons 2 recorded in the insurer dispensing receipt DB52, and calculates the prescription contents (type and amount of prescribed drug) for each insured person 2 prescribed in the same manner during a unit period for all insured persons 2, and stores them in the first prescription content DB53.

[0034] The database generation unit 14 generates a second prescription content DB 54 that stores prescription contents (type and amount of prescribed drug) for each dispensing pharmacy 4 prescribed during a unit period, based on the information recorded in the generated insurer dispensing receipt DB 52 (step S104). Specifically, the database generation unit 14 identifies information on all prescription data issued during the unit period linked to the identifier of one dispensing pharmacy 4 recorded in the insurer dispensing receipt DB 52, and reads the prescription contents included in that information from the insurer dispensing receipt DB 52. The database generation unit 14 instructs the prescription content calculation unit 13 to calculate the prescription amount per unit period for each type of prescription drug included in the prescription contents. The prescription content calculation unit 13 calculates the prescription amount for each prescription drug dispensed by one dispensing pharmacy 4, based on all prescription data issued by that dispensing pharmacy 4 during the unit period. For example, the prescription content calculation unit 13 calculates the prescription amount of one prescription drug per unit period for each of the above-mentioned insured persons 2 for each of the multiple insured persons 2 processed by the dispensing pharmacy 4, and calculates the sum as the prescription amount of that one prescription drug per unit period. This prescription amount is also an example of statistical information for the unit period. The prescription content calculation unit 13 similarly calculates the prescription amount for each prescription drug handled by one dispensing pharmacy 4, and outputs it to the database generation unit 14. The database generation unit 14 generates the second prescription content DB 54 by linking the identifier of the dispensing pharmacy 4, the type of prescription drug, and the prescription amount of the prescription drug per unit period.

[0035] As in the generation of the first prescription content DB53, the type of prescription drug may be a type represented by the brand name by strength or the generic name of the prescription drug and its strength. The amount of prescription drug may be the total strength prescribed for the type indicated by the prescription drug during a unit period. Furthermore, the database generation unit 14 may identify multiple prescription drug types that have a relationship between an original drug and a generic drug as the same type based on the type of prescription drug and the relationship between the original drug and the generic drug recorded in the master DB, and generate the second prescription content DB54. In this case, the prescription drug types of the original drug and the corresponding generic drug may be included in the second prescription content DB54 as the same type. The database generation unit 14 determines whether processing has been performed for all dispensing pharmacy 4 types recorded in the insurer dispensing receipt DB52, and similarly calculates the prescription details (type and amount of prescribed drug) for each dispensing pharmacy 4 prescribed during a unit period for all dispensing pharmacies 4 and stores them in the second prescription content DB54.

[0036] The database generation unit 14 generates a third prescription content DB 55 that stores prescription details (type and amount of prescribed drug) for each drug prescribed during a unit period based on the information recorded in the generated insurer dispensing receipt DB 52 (step S105). Specifically, the database generation unit 14 identifies information on all prescription data issued during the unit period from among the prescription data recorded in the insurer dispensing receipt DB 52, and reads the prescription details included in that information from the insurer dispensing receipt DB 52. The database generation unit 14 outputs an instruction to calculate the prescription amount per unit period for each type of prescription drug included in the prescription details to the prescription content calculation unit 13. The prescription content calculation unit 13 totals the prescription amounts for each prescription drug handled by each dispensing pharmacy 4 calculated in generating the second prescription content DB 54, calculates the prescription amount per unit period for each prescription drug, and outputs the total to the database generation unit 14. The prescription amount is also an example of statistical information for the unit period. The database generating unit 14 generates a third prescription content DB 55 that associates the type of prescribed drug with the prescribed amount of the prescribed drug per unit period and stores the prescribed amount for each prescribed drug.

[0037] As with the generation of the first prescription content DB53, the type of prescription drug may be a type represented by the brand name by strength or the generic name of the prescription drug and its strength. The prescription amount of the prescription drug may be the total strength prescribed for the type indicated by the prescription drug in the unit period. Furthermore, the database generation unit 14 may identify multiple prescription drug types that have a relationship between an original drug and a generic drug as the same type based on the type of prescription drug and the relationship between the original drug and the generic drug recorded in the master DB, and generate the third prescription content DB55. In this case, the prescription drug types of the original drug and the corresponding generic drug of the original drug may be included in the third prescription content DB55 as the same type. The database generation unit 14 determines whether all prescription drugs included in the receipt data for the unit period recorded in the insurer dispensing receipt DB52 have been processed, and calculates the prescription amounts prescribed for all prescription drug types in the unit period in the same way and stores them in the third prescription content DB55.

[0038] The control unit 11 controls the database generation unit 14 to generate each of the above DBs for each unit period. Thereafter, the control unit 11 detects a predetermined timing for instructing the start of analysis (step S106). The timing may be preprogrammed or may be input by an administrator to the management device 10. At that timing, the control unit 11 outputs analysis start information for statistical information related to prescriptions, including a past analysis period and analysis interval, to the prescription content acquisition unit 15 and the purchase information estimation unit 16. The analysis period may be, for example, a past period for estimating the purchase amount of future prescription drugs for bulk purchase, such as several years up to last year (analysis period) and one-year units (analysis interval), or half-year units from January to June of the past several years (analysis period). Assume that the prescription content acquisition unit 15 receives analysis start information including one-year units for the past five years from the control unit 11. In this case, the prescription content acquisition unit 15 acquires information for each year (analysis interval) for the past five years (analysis period) from the first prescription content DB 53, the second prescription content DB 54, and the third prescription content DB 55 (step S107).

[0039] In other words, if the analysis period and analysis interval are in units of one year over the past five years, the prescription content acquisition unit 15 acquires from the first prescription content DB 53 the prescription amount of each type of prescription drug prescribed to each insured person 2 over the past five years. In addition, if the analysis period and analysis interval are in one-year increments over the past five years, the prescription content acquisition unit 15 acquires from the second prescription content DB 54 the prescription amounts of each type of prescription drug dispensed by the dispensing pharmacy 4 over the past five years for each dispensing pharmacy 4. Furthermore, when the analysis period and analysis interval are in units of one year over the past five years, the prescription content acquisition unit 15 acquires from the third prescription content DB 55 the prescription amounts of a certain prescription drug dispensed at all dispensing pharmacies 4 that dispensed for the insured person 2 over a five-year period for each prescription drug. If the analysis period or analysis interval is another period or interval, the prescription content acquisition unit 15 acquires information corresponding to the analysis interval or analysis interval from the first prescription content DB 53, the second prescription content DB 54, and the third prescription content DB 55.

[0040] The prescription content acquisition unit 15 outputs the information acquired from the first prescription content DB 53, the second prescription content DB 54, and the third prescription content DB 55 to the purchase information estimation unit 16. The purchase information estimation unit 16 analyzes the prescription content information and estimates the type and amount of prescription drugs to be purchased in bulk (step S108). For example, when estimating the type and amount of prescription drugs to be purchased in bulk, the purchase information estimation unit 16 uses the prescription amounts of each prescription drug dispensed by all dispensing pharmacies 4 during the analysis period and analysis interval (one year for the past five years) acquired by the prescription content acquisition unit 15 from the third prescription content DB 55. The purchase information estimation unit 16 identifies prescription drugs that have been prescribed in amounts equal to or greater than a predetermined threshold over the past five years according to a predetermined program. The purchase information estimation unit 16 may identify the identified prescription drugs as prescription drugs to be purchased in bulk. The purchase information estimation unit 16 may specify the prescription amount calculated using a predetermined calculation formula, such as 80% of the prescription amount of the prescription drug identified as the target for bulk purchase, as the prescription amount to be purchased in bulk for the next year. The identification of the prescription drug to be purchased in bulk and the calculation of the prescription amount for the next unit period (one year) may be performed using any calculation formula. For example, if the total prescription amount of the prescription drug identified as the target for bulk purchase at all dispensing pharmacies 4 over the past five years has been on an increasing trend, the purchase information estimation unit 16 may multiply the prescription amount for the previous year by the average annual increase rate to specify the prescription amount for the prescription drug identified as the target for bulk purchase over the next year, and specify this prescription amount as the amount to be purchased in bulk.

[0041] The purchase information estimation unit 16 may estimate the type and amount of prescription drugs to be bulk-purchased using an estimation model generated by machine learning. Specifically, the estimation model may be a learning model generated by machine learning the relationship between the prescription amount of each prescription drug prescribed by all dispensing pharmacies 4 during a past analysis period or analysis interval (one or more analysis periods or analysis intervals) and the prescription drugs identified as being bulk-purchased in the next unit period and their amounts (bulk purchase amounts). Alternatively, the estimation model may be a learning model generated by machine learning the relationship between each piece of information for each past period or interval stored in the first prescription content DB 53, the second prescription content DB 54, and the third prescription content DB 55 and the type and amount of prescription drugs to be bulk-purchased based on the information for that period or interval. The purchase information estimation unit 16 inputs the prescription amounts of each prescription drug dispensed by all dispensing pharmacies 4 during the analysis period or analysis interval (one year increments over the past five years) into the estimation model. As a result, the purchase information estimation unit 16 obtains the prescription drugs identified as being bulk-purchased in the next unit period and their amounts (bulk purchase amounts) as the calculation results of the estimation model. This process is an example of a process in which the purchasing information estimation unit 16 estimates the type and quantity of prescription drugs to be purchased in bulk based on a learning model generated based on past prescription records and statistical information on prescription contents related to prescription drugs.

[0042] The estimation model may be machine-learned, including seasonal index conditions (temperature, humidity, number of typhoons, pollen count, etc. for each unit period) for past analysis periods and analysis intervals (one or more analysis periods or analysis intervals). When estimating the type and amount of prescription drugs to be bulk-purchased, the purchase information estimation unit 16 may input the predicted seasonal index conditions for the next unit period into the estimation model, and as a result, obtain from the estimation model the prescription drugs identified as being subject to bulk purchase in the next unit period and their amounts (bulk purchase amount).

[0043] The purchasing information estimation unit 16 may estimate the type and quantity of prescription drugs to be purchased in bulk using other methods. For example, the purchasing information estimation unit 16 may compare drug prices for prescription drugs with the same generic name and potency in the same drug unit, and confirm the cost reduction effect associated with substituting the drug unit with the cheapest drug price. Specifically, the purchasing information estimation unit 16 compares drug prices for prescription drugs with the same drug unit and calculates the prescription amount when substituting the drug unit with the cheapest drug price. The purchasing information estimation unit 16 may then estimate the type and quantity of prescription drugs to be purchased in bulk, similar to the above, based on the prescription amount during the past analysis period and analysis interval when substituting the drug unit with the cheapest drug price. Note that the purchasing information estimation unit 16 may estimate the type and quantity of prescription drugs to be purchased in bulk using any processing.

[0044] Furthermore, the purchase information estimation unit 16 may be a processing unit that generates and outputs information for analyzing and identifying the types and amounts of prescription drugs to be purchased in bulk by the administrator. For example, the purchase information estimation unit 16 may generate and output graphs of statistical information obtained from the first prescription content DB 53, the second prescription content DB 54, and the third prescription content DB 55 based on the past analysis period and analysis interval, and as a result, input information on the types and amounts of prescription drugs to be purchased in bulk in the next specified future period estimated by the administrator.

[0045] The purchase information estimation unit 16 outputs the types and quantities of prescription drugs to be purchased in bulk in the next unit period to the pharmaceutical company management unit 17. The pharmaceutical company management unit 17 may transmit the types and quantities of prescription drugs to be purchased in bulk to the pharmaceutical company terminals 50 of multiple pharmaceutical companies 5 to process bidding. The management device 10 may include a bidding system function using a web server, and the bidding system function may display the types and quantities of prescription drugs to be purchased in bulk in the next unit period and process bidding based on access from the pharmaceutical company terminals 50. The pharmaceutical company management unit 17 may place an order, process purchases, and process payments with the pharmaceutical company 5 from which prescription drugs are to be purchased in bulk, identified as a result of the bidding process. The pharmacy management unit 18 may identify a supplier terminal 60 based on the pharmaceutical company 5 identified as a result of the bidding process, and instruct the supplier terminal 60 to process allocations to dispensing pharmacies 4. In this case, the pharmacy management unit 18 calculates the allocation amount to be allocated to each dispensing pharmacy 4 based on the type and amount of the prescription drug to be purchased in bulk and the proportion of the prescription amount during the past analysis period and analysis interval at each dispensing pharmacy 4 that dispensed the prescription drug. The pharmacy management unit 18 may output an allocation processing instruction including the allocation amount to be allocated to each dispensing pharmacy 4 to the supplier terminal 60. The supplier that manages the supplier terminal 60 then delivers the prescription drug to each dispensing pharmacy 4 based on the allocation amount.

[0046] The above describes one embodiment of the present disclosure. According to the processing of the direct pharmaceutical benefit management system 100 and the management device 10, statistical information on the prescription contents for each of multiple prescription drugs calculated based on information related to the prescription drugs is acquired, and the prescription contents are analyzed to estimate the type and quantity of prescription drugs to be purchased in bulk. By purchasing prescription drugs identified by the insurer 1 in bulk, the costs of multiple dispensing pharmacies 4 purchasing prescription drugs individually can be reduced. Furthermore, by identifying drugs prescribed in large quantities, purchasing them in bulk, and managing the allocation of drugs to each dispensing pharmacy 4, the insurer 1 can reduce the costs of prescription drugs prescribed to insured persons 2, thereby reducing the medical expenses borne by the government and insured persons 2, as well as the drug procurement efforts of dispensing pharmacies 4.

[0047] The purchase information estimation unit 16 may further estimate the purchase timing of prescription drugs to be bulk-purchased based on statistical information on prescription contents. For example, the purchase information estimation unit 16 may determine the timing immediately before the prescription amount increases as the purchase timing based on the increase or decrease in the prescription amount of each prescription drug at all dispensing pharmacies 4 for each past unit period of three months. The timing immediately before the prescription amount increases may be determined, for example, based on past statistical information, as the timing when the prescription amount for each analysis interval (e.g., March of the previous year) is higher by a predetermined percentage than the previous analysis interval (e.g., February of the previous year). In January or February of the following year, the purchase timing may be determined as the timing immediately before March of that year. Alternatively, when seasonal index conditions (e.g., temperature, humidity, number of typhoons, pollen count, etc.) for the previous unit period (one month) are input, prescription drugs whose prescription amount increases according to the seasonal index conditions may be identified, and the purchase timing for the next unit period (one month) may be determined. This allows the timing of purchase to be determined in accordance with the increase or decrease in the amount of prescribed medicines in response to seasonal events. The purchase information estimation unit 16 may determine the timing of purchase in any way based on past statistical information and algorithms.

[0048] The prescription information acquisition unit 12 may acquire information about prescription drugs included in the medical fee statement for each insured person 2, as well as prescription timing (prescription date and time, number of prescriptions per unit period), etc. Then, the guidance information generation unit 19 may generate guidance information regarding the use of prescription drugs based on the information about prescription drugs for each insured person 2 and the prescription timing. The guidance information may be any information related to the use of prescription drugs. The guidance information generation process may be performed according to a predetermined program. For example, a guidance text template defined according to the number of prescriptions per unit period included in the prescription timing may be obtained from a database, and guidance information including the guidance text may be generated. The guidance information generation unit 19 identifies the dispensing pharmacy 4 used by the insured person 2 based on the relationship between the receipt data stored in the insurer's entire receipt DB 51 and the identifier of the dispensing pharmacy 4. Then, the guidance information generation unit 19 transmits the generated guidance information for the insured person 2 to the pharmacy terminal 40 of the identified dispensing pharmacy 4.

[0049] Although the present disclosure has been described above with reference to the embodiments, the present disclosure is not limited to the above-described embodiments.

[0050] Some or all of the above-described embodiments can be described as, but are not limited to, the following supplementary notes.

[0051] (Appendix 1) a prescription information acquisition means for acquiring information related to prescription drugs included in a medical fee statement for each of a plurality of prescription drugs; a prescription content acquisition means for acquiring statistical information on prescription content for each of the plurality of prescribed drugs calculated based on information related to the prescribed drugs; a purchasing information estimation means for estimating the type and amount of prescription drugs to be purchased in bulk by analyzing the prescription contents; A payer-based direct pharmacy benefit management system with

[0052] (Appendix 2) prescription content calculation means for calculating statistical information of the prescription content for each of the plurality of prescribed drugs based on information related to the prescribed drugs; 2. The insurer direct pharmacy benefit management system of claim 1, comprising:

[0053] (Appendix 3) The purchasing information estimation means The type and amount of the prescription drug to be purchased in bulk are estimated based on a learning model generated based on past prescription records and statistical information on the prescription content related to the prescription drug. The payer direct pharmacy benefit management system described in Appendix 3.

[0054] (Appendix 4) The prescription information acquisition means acquires information related to the prescribed drugs included in the medical fee statements handled at the plurality of pharmacies for each of the plurality of prescribed drugs; the prescription content indicates the relationship between the type and the prescribed amount of each of the prescribed drugs; The purchasing information estimation means estimates the types and quantities of prescription drugs to be supplied to the pharmacies and to be bulk-purchased based on statistical information on prescription contents for each of the prescription drugs prescribed at the pharmacies. The payer direct pharmacy benefit management system described in Appendix 1.

[0055] (Appendix 5) The purchase information estimation means further estimates the purchase timing of the prescription medicines to be purchased in bulk based on the statistical information of the prescription contents. The payer direct pharmacy benefit management system described in Appendix 4.

[0056] (Appendix 6) The prescription information acquisition means acquires information about prescription drugs and prescription timing included in the medical fee statement for each insured person, an instruction information generating means for generating instruction information regarding the use of the prescribed drugs based on information about the prescribed drugs for each of the insured persons and the prescription timing; 10. The insurer direct pharmacy benefit management system of claim 1, comprising:

[0057] (Appendix 7) a prescription information acquisition means for acquiring information related to prescription drugs included in a medical fee statement for each of a plurality of prescription drugs; a prescription content acquisition means for acquiring statistical information on prescription content for each of the plurality of prescribed drugs calculated based on information related to the prescribed drugs; a purchasing information estimation means for estimating the type and amount of prescription drugs to be purchased in bulk by analyzing the prescription contents; An information processing device comprising:

[0058] (Appendix 8) Obtaining information related to prescription drugs included in a medical fee statement for each of a plurality of prescription drugs; acquiring statistical information on prescription contents for each of the plurality of prescribed drugs calculated based on information related to the prescribed drugs; The prescription contents are analyzed to estimate the type and amount of prescription drugs to be purchased in bulk. Information processing methods.

[0059] (Appendix 9) Computer, prescription information acquisition means for acquiring information related to prescription drugs included in a medical fee statement for each of a plurality of prescription drugs; prescription content acquisition means for acquiring statistical information on prescription content for each of the plurality of prescribed drugs calculated based on information related to the prescribed drugs; a purchasing information estimation means for estimating the type and amount of prescription drugs to be purchased in bulk by analyzing the prescription contents; A program that functions as a [Explanation of symbols]

[0060] 10...Management device 11 Control section 12. Prescription information acquisition unit 13. Prescription content calculation section 14. Database generation section 15. Prescription Content Acquisition Unit 16. Purchasing Information Estimation Department 17···Pharmaceutical Company Administration Department 18···Pharmacy Management Department 19...Guidance information generation department 20 Insurer Server 30 Medical institution server 40···Pharmacy terminal 50 Pharmaceutical company terminal 60 Supplier terminal 100···Direct Pharmacy Benefit Management System

Claims

1. a prescription information acquisition means for acquiring information related to prescription drugs included in a medical fee statement for each of a plurality of prescription drugs; a prescription content acquisition means for acquiring statistical information on prescription content for each of the plurality of prescribed drugs calculated based on information related to the prescribed drugs; a purchasing information estimation means for estimating the type and amount of prescription drugs to be purchased in bulk by analyzing the prescription contents; A payer-based direct pharmacy benefit management system with

2. prescription content calculation means for calculating statistical information of the prescription content for each of the plurality of prescribed drugs based on information related to the prescribed drugs; The payer direct pharmacy benefit management system of claim 1, comprising:

3. The purchasing information estimation means The type and amount of the prescription drug to be purchased in bulk are estimated based on a learning model generated based on past prescription records and statistical information on the prescription content related to the prescription drug. The payer direct pharmacy benefit management system of claim 2 .

4. The prescription information acquisition means acquires information related to the prescribed drugs included in the medical fee statements handled at the plurality of pharmacies for each of the plurality of prescribed drugs; the prescription content indicates the relationship between the type and the prescribed amount of each of the prescribed drugs; The purchasing information estimation means estimates the types and quantities of prescription drugs to be supplied to the pharmacies and to be bulk-purchased based on statistical information on prescription contents for each of the prescription drugs prescribed at the pharmacies. The payer direct pharmacy benefit management system of claim 1 .

5. The purchase information estimation means further estimates the purchase timing of the prescription medicines to be purchased in bulk based on the statistical information of the prescription contents. The payer direct pharmacy benefit management system of claim 4 .

6. The prescription information acquisition means acquires information about prescription drugs and prescription timing included in the medical fee statement for each insured person, an instruction information generating means for generating instruction information regarding the use of the prescribed drugs based on information about the prescribed drugs for each of the insured persons and the prescription timing; The payer direct pharmacy benefit management system of claim 1, comprising:

7. a prescription information acquisition means for acquiring information related to prescription drugs included in a medical fee statement for each of a plurality of prescription drugs; a prescription content acquisition means for acquiring statistical information on prescription content for each of the plurality of prescribed drugs calculated based on information related to the prescribed drugs; a purchasing information estimation means for estimating the type and amount of prescription drugs to be purchased in bulk by analyzing the prescription contents; An information processing device comprising:

8. Obtaining information related to prescription drugs included in a medical fee statement for each of a plurality of prescription drugs; acquiring statistical information on prescription contents for each of the plurality of prescribed drugs calculated based on information related to the prescribed drugs; The prescription contents are analyzed to estimate the type and amount of prescription drugs to be purchased in bulk. Information processing methods.

9. Computer, prescription information acquisition means for acquiring information related to prescription drugs included in a medical fee statement for each of a plurality of prescription drugs; prescription content acquisition means for acquiring statistical information on prescription content for each of the plurality of prescribed drugs calculated based on information related to the prescribed drugs; a purchasing information estimation means for estimating the type and amount of prescription drugs to be purchased in bulk by analyzing the prescription contents; A program that functions as a

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