Insurers' direct drug benefit management system, information processing device, information processing method, program

Abstract

This system provides a direct drug benefit management system for insurers that reduces the costs associated with providing prescription drugs. [Solution] Information related to prescription drugs included in the medical fee statement is obtained for each of the multiple prescription drugs. Statistical information on the prescription content is obtained for each of the multiple prescription drugs calculated based on the information related to the prescription drugs. The type and quantity of prescription drugs to be purchased in bulk are estimated by analyzing the prescription content.

Description

Technical Field

[0001] The present disclosure relates to a direct drug payment management system by an insurer, an information processing apparatus, an information processing method, and a program.

Background Art

[0002] A purchase order management system is disclosed in Patent Document 1, which creates an operating organization for a co-purchase system of drugs and the like, and virtually manages the inventories of drugs and the like in a plurality of dispersed medical institutions, dispensing pharmacies, etc. in a unified manner, thereby jointly and centrally performing the purchase of drugs and the like that have been individually performed by each medical institution and pharmacy.

Prior Art Documents

Patent Documents

[0003]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0004] In the above-described technology, a technology capable of reducing the cost related to the payment of prescription drugs is desired.

[0005] An object of the present disclosure is to provide a direct drug payment management system by an insurer, an information processing apparatus, an information processing method, and a program that solve the above problems.

Means for Solving the Problems

[0006] A direct drug payment management system by an insurer according to an aspect of the present disclosure includes a prescription information acquisition unit that acquires information related to prescription drugs included in a medical fee statement for each of a plurality of prescription drugs, a prescription content acquisition unit that acquires 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 unit that analyzes the prescription content and estimates the type and quantity of prescription drugs to be subject to bulk purchase.

[0007] An information processing device according to one aspect of this disclosure includes: 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 the prescription content for each of the plurality of prescription drugs calculated based on the information related to the prescription drugs; and procurement information estimation means for estimating the type and quantity of prescription drugs to be procured in bulk by analyzing the prescription content.

[0008] An information processing method relating to one aspect of this disclosure involves obtaining information related to prescription drugs included in medical fee statements for each of several prescription drugs, obtaining statistical information on the prescription content for each of the several prescription drugs calculated based on the information related to the prescription drugs, and analyzing the prescription content to estimate the type and quantity of prescription drugs to be purchased in bulk.

[0009] A program relating to one aspect of this 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 several prescription drugs; a prescription content acquisition means for acquiring statistical information on the prescription content for each of the several prescription drugs calculated based on the information related to the prescription drugs; and a procurement information estimation means for estimating the type and quantity of prescription drugs to be procured in bulk by analyzing the prescription content. [Effects of the Invention]

[0010] According to the above embodiment, the costs associated with providing prescription drugs can be reduced. [Brief explanation of the drawing]

[0011] [Figure 1] This figure shows the relationship between objects related to a drug distribution system according to one aspect of this disclosure. [Figure 2] This figure shows the system configuration of a drug distribution system according to one aspect of the present disclosure. [Figure 3] This figure shows the hardware configuration of a control device according to one aspect of the present disclosure. [Figure 4] This is a functional block diagram of a control device according to one aspect of the present disclosure. [Figure 5] This figure shows an example of a database provided by a management device according to one aspect of this disclosure. [Figure 6] This figure shows the processing flow of a control device according to one aspect of this disclosure. [Modes for carrying out the invention]

[0012] In Japan's health insurance system, insurers are required to provide insurance benefits in the form of "medical treatment," and in the case of pharmaceuticals, the pharmaceuticals are provided to the insured person as in-kind benefits at a medical institution or dispensing pharmacy based on a prescription from the physician in charge of medical treatment.

[0013] This legal framework is based on a predetermined "delegation" from the insurer to the healthcare provider, and until now, the insurer has never been directly involved in the selection of medications covered by insurance.

[0014] In Japan, physicians have strong prescribing rights, and insurers have no say in which medications to prescribe to each insured person according to their medical condition. However, if the medication is of the same type as a previously prescribed drug, insurers can decide which pharmaceutical company's product to provide without infringing on the physician's prescribing rights.

[0015] If that is the case, it is perfectly reasonable for the insurer to determine the product that is most economically rational for insurance purposes and to provide that product to the insured.

[0016] Until now, Japan has lacked the concept of insurers managing drug benefits themselves based on accurate benefit data (medical fee statements), and consequently, no system has been devised to do so.

[0017] In the health insurance system of Japan, the caregiver is required to bill the insurer every month for the expenses incurred for medical treatment, together with the details thereof, and the insurer has extremely detailed data on monthly drug benefits.

[0018] Using this data, it is possible to clarify which drugs are being dispensed to which insured persons and how much, thereby identifying the drugs that are determined to be prescribed and dispensed in the future, designating the most economically reasonable and suitable drug for reimbursement among multiple drugs with the same efficacy, and then the insurer purchases them in a lump sum, making it possible to optimize the costs related to the benefits.

[0019] One of the problems that the present disclosure aims to solve is "which drug should the insurer select as the object of benefit payment to enable the most appropriate drug benefit payment", and as a means thereto, a system for analyzing and determining data on medical fee details, a direct purchase system for the drug, a system for determining the dispensing pharmacy as the object and a distribution system for dispensing the drug to the dispensing pharmacy, and a system that can provide data related to appropriate guidance and the like when the dispensing pharmacy makes a drug benefit payment to the insured person.

[0020] Hereinafter, the information processing apparatus of the present disclosure will be described with reference to the drawings. FIG. 1 is a diagram showing the relationship of objects related to a direct drug benefit management system by an insurer according to an aspect of the present disclosure. As objects related to the direct drug benefit management system 100 including the information processing apparatus of the present disclosure, an insurer 1, an insured person 2, a medical institution 3, a dispensing pharmacy 4, a pharmaceutical company 5, etc. are included. The insurer 1 is, for example, an entity that conducts a health insurance business such as a health insurance union defined in the health insurance system of Japan. The insured person 2 is a person who has joined the health insurance as defined in the health insurance system of Japan. The medical institution 3 conducts medical treatment for the insured person 2, and the dispensing pharmacy 4 receives a prescription from a doctor prescribed to the insured person 2 from the insured person 2 and conducts dispensing and the like. The pharmaceutical company 5 is a company or the like that manufactures and sells prescription drugs and the like used in the dispensing pharmacy 4.

[0021] Insured person 2 receives medical treatment at medical institution 3. Medical institution 3 gives a prescription to insured person 2, who is the patient. Insured person 2 takes the prescription to a dispensing pharmacy 4, etc. Pharmacy 4 dispenses the medication and receives a portion of the payment from the patient. Pharmacy 4 submits a claim for dispensing fees to insurer 1. Medical institution 3 sends medical fee statement data (receipt data) to insurer 1. The medical fee statement and dispensing fee claim together are also called a "medical and dispensing fee claim statement".

[0022] Insurer 1 then manages prescription drugs using the direct drug benefit management system 100 described herein. Specifically, Insurer 1 uses the direct drug benefit management system 100 to bid on the purchase of drugs from pharmaceutical companies 5, and places orders for, purchases, and payments for prescription drugs to pharmaceutical companies 5 that are bidders. Insurer 1 also manages the allocation and inventory of the purchased drugs. The drugs purchased by Insurer 1 may be delivered to Insurer 1 and distributed by Insurer 1, or they may be delivered to a designated supplier and distributed to each dispensing pharmacy 4 according to Insurer 1's instructions. Insurer 1 may also provide information regarding the prescriptions of insured persons 2. Dispensing pharmacies 4 may provide medication guidance, etc., based on the information regarding the prescriptions of insured persons 2 provided by the insurance company.

[0023] Figure 2 shows the system configuration of a direct drug disbursement management system according to one aspect of this disclosure. The direct drug benefit management system 100 shown in Figure 2 is composed of, 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 insurer 1 or an information processing company commissioned by insurer 1. The insurer server 20 may be managed by insurer 1. The medical institution server 30 may be managed by medical institution 3. The pharmacy terminal 40 may be managed by dispensing pharmacy 4. The pharmaceutical company terminal 50 may be managed by 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 in this disclosure.

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

[0025] Figure 4 is a functional block diagram of a control device according to one aspect of this disclosure. The management device 10 executes the drug distribution management program. As a result, the management device 10 performs the functions of the control unit 11, prescription information acquisition unit 12, prescription content calculation unit 13, database generation unit 14, prescription content acquisition unit 15, procurement information estimation unit 16, pharmaceutical company management unit 17, pharmacy management unit 18, and guidance information generation unit 19.

[0026] The control unit 11 controls the management device 10. The prescription information acquisition unit 12 acquires information related to the prescribed drugs included in the medical fee statement for each of the multiple prescribed drugs. The prescription content calculation unit 13 calculates statistical information on the prescription content for each of the multiple prescribed drugs based on information related to the prescribed drugs. The database generation unit 14 generates a database using information such as statistical information on the prescription details for each prescribed drug. The prescription information acquisition unit 15 acquires statistical information on the prescription details for each of the multiple prescribed drugs. The procurement information estimation unit 16 analyzes the prescription details to estimate the type and quantity of prescription drugs to be purchased in bulk. The pharmaceutical company's management department (17) processes information related to bidding, ordering, purchasing, payment, and delivery of prescription drugs that are subject to bulk procurement. The pharmacy management department 18 is responsible for the distribution of prescription drugs subject to bulk purchasing and for managing the provision of information on insured persons 2 to dispensing pharmacies 4. The instruction information generation unit 19 generates instruction information.

[0027] The management device 10 in this disclosure acquires information related to prescription drugs included in the medical fee statement for each of the multiple prescription drugs, and analyzes the prescription content based on statistical information of the prescription content for each of the multiple prescription drugs calculated based on the information related to the prescription drugs to estimate the type and quantity of prescription drugs to be purchased in bulk. As a result, the insurer 1 can reduce the costs related to prescription drugs prescribed to insured persons 2 by identifying drugs that are prescribed in large quantities, purchasing those drugs in bulk, and managing the allocation of drugs to each dispensing pharmacy 4, thereby reducing the cost burden on the government and insured persons 2, etc., related to medical care.

[0028] Figure 5 shows an example of a database provided by a management device according to one aspect of this 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 this disclosure include the insurer's overall receipt DB 51, the insurer's dispensing receipt DB (DataBase) 52, the first prescription details DB 53 for each insured person 2, the second prescription details DB 54 for each dispensing pharmacy 4, the third prescription details DB 55 for each drug unit, and so on.

[0029] The insurer's complete claims database (DB51) stores all claims data for insured individuals (2) who are enrolled in the health insurance program of insurer 1. The insurer's prescription data database 52 stores information contained in prescription data issued during a unit period and the identifier of the dispensing pharmacy 4 that issued the prescription based on that prescription data. The first prescription details database (DB53) stores the prescription details (type and quantity of prescribed medication) for each insured person within a unit period. The second prescription details database, DB54, stores the details of each prescription (type and quantity of prescribed medication) issued by multiple pharmacies 4 during a given period. The third prescription details database, DB55, stores the prescription details (type and quantity of prescribed medication) for each individual drug prescribed during a given period.

[0030] Figure 6 shows the processing flow of a control device according to one aspect of this disclosure. The insurer server 20 stores in advance the information included in the dispensing fee claim (such as the identifier of the dispensing pharmacy 4) that the medical institution server 30 has sent and linked. The data stored by the insurer server 20 may be the medical and dispensing fee claim statement mentioned above. The prescription information acquisition unit 12 of the management device 10 acquires the medical claim data stored by the insurer server 20 and stores it in the insurer's all-claims DB 51.

[0031] The prescription information acquisition unit 12 of the management device 10 reads the claim data stored in the insurer's total claim DB 51 and the identifier of the dispensing pharmacy 4 that dispensed the medication based on that claim data (step S101). The prescription information acquisition unit 12 outputs the acquired claim 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 the claim data stored in the insurer server 20 that includes the date of each day of the unit period as the issue date, etc. The unit period may be, for example, the month of the previous month. Alternatively, the unit period may be one month prior, two months prior, three months prior. Alternatively, the unit period may be six months or one year. The database generation unit 14 extracts information related to prescribed medications (type of prescribed medication, prescribed quantity, etc.) from the information contained in the acquired claims data and generates an insurer's prescription claims DB 52 that stores prescription details (type of prescribed medication, prescribed quantity as described in each claims data) linked to the identifier of the insured person 2, the identifier of the dispensing pharmacy 4 that dispensed the medication, the identifier of the unit period, etc. (step S102). The insurer's prescription claims DB 52 may also store other information extracted from the claims data, other than the identifier of the insured person 2, the identifier of the dispensing pharmacy 4 that dispensed the medication, and the identifier of the unit period. The database generation unit 14 writes the insurer's prescription claims DB 52 to the storage device 104. The storage device 104 may be configured as RAID or the like. The database generation unit 14 repeats the same process and adds information for each unit period to the insurer's prescription claims DB 52.

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

[0033] The type of prescribed drug may be expressed by its potency-based trade name, or by its generic name and its potency. The quantity of the prescribed drug may be the total potency of the prescribed drug of the type indicated by the drug prescribed during a unit period. The storage device 104 pre-stores a drug master DB 50 that shows the relationship between the original drug and generic drugs that contain the same active ingredient in the same amount as the original drug and have the same efficacy and effects. The database generation unit 14 may identify multiple prescription drug types that have a relationship between the original drug and the generic drug recorded in the master DB as the same type and generate the first prescription content DB 53. In this case, the prescription drug types of the original drug and its corresponding generic 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 DB 52, and similarly calculates the prescription details (type and quantity of prescribed medication) for each insured person 2 prescribed during the unit period and stores them in the first prescription details DB 53.

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

[0035] Similar to the generation of the first prescription details DB53, the type of prescribed drug may be represented by the brand name by potency, or by the generic name of the prescribed drug and its potency. The quantity of the prescribed drug may be the total potency of the prescribed drug of the type indicated by the prescribed drug prescribed during a unit period. The database generation unit 14 may also generate the second prescription details DB54 by identifying multiple prescription drug types that have a relationship between a brand-name drug and a generic drug as the same type, based on the type of prescribed drug and the relationship between brand-name drugs and generic drugs recorded in the master DB. In this case, the types of prescribed drugs of the brand-name drug and its corresponding generic drug may be included in the second prescription details DB54 as the same type. The database generation unit 14 determines whether it has processed all types of dispensing pharmacies 4 recorded in the insurer dispensing claim DB52, and similarly calculates the prescription details (type and quantity 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 details DB54.

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

[0037] Similar to the generation of the first prescription details DB53, the type of prescribed drug may be represented by the brand name by potency, or by the generic name of the prescribed drug and its potency. The prescribed quantity of the prescribed drug may be the total potency of the prescribed drug of the type indicated by the prescribed drug prescribed during the unit period. The database generation unit 14 may also identify multiple prescription drug types that have a relationship between a brand-name drug and a generic drug as the same type, based on the type of prescribed drug and the relationship between brand-name drugs and generic drugs recorded in the master DB, and generate the third prescription details DB55. In this case, the types of prescribed drugs of the brand-name drug and its corresponding generic drug may be included in the third prescription details DB55 as the same type. The database generation unit 14 determines whether it has processed all prescription drugs included in the claim data for the unit period recorded in the insurer dispensing claim DB52, and similarly calculates the prescribed quantity for all prescription drug types prescribed during the unit period and stores it in the third prescription details DB55.

[0038] The control unit 11 controls the database generation unit 14 to generate each of the above DBs for each unit period. Subsequently, the control unit 11 detects a predetermined timing to instruct the start of analysis (step S106). This timing may be pre-programmed or entered by the administrator into the management device 10. At that timing, the control unit 11 outputs analysis start information for statistical information related to prescriptions, including past analysis periods and analysis intervals, 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 quantity for bulk purchases of future prescription drugs, and may be information such as several years up to last year (analysis period) and one-year units (analysis interval), or six-month units from January to June of the past several years (analysis period) (analysis interval). The prescription content acquisition unit 15 may, for example, receive 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) over 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 set to one-year units over the past five years, the prescription content acquisition unit 15 acquires the prescription quantity for each type of prescribed drug prescribed to each insured person 2 over a five-year period from the first prescription content DB 53. Furthermore, if the analysis period and analysis interval are set to one-year units over the past five years, the prescription content acquisition unit 15 acquires the prescription volume for each type of prescription drug dispensed by each pharmacy 4 over a five-year period from the second prescription content DB 54. Furthermore, if the analysis period and analysis interval are set to one-year units over the past five years, the prescription content acquisition unit 15 acquires the prescription quantities for each prescribed drug dispensed at all dispensing pharmacies 4 that dispensed medication for the insured person 2 from the third prescription content DB 55 for a five-year period. If the analysis period or analysis interval is different, the prescription content acquisition unit 15 acquires information corresponding to that analysis interval from the first prescription content DB 53, second prescription content DB 54, and third prescription content DB 55.

[0040] The prescription information acquisition unit 15 outputs the information acquired from the first prescription information DB 53, the second prescription information DB 54, and the third prescription information DB 55 to the procurement information estimation unit 16. The procurement information estimation unit 16 analyzes the prescription information to estimate the type and quantity of prescription drugs to be purchased in bulk (step S108). For example, in estimating the type and quantity of prescription drugs to be purchased in bulk, the procurement information estimation unit 16 uses the prescription quantities of each prescription drug dispensed by all pharmacies 4 during the analysis period and analysis interval (1-year units over the past 5 years), which the prescription information acquisition unit 15 acquired from the third prescription information DB 55. The procurement information estimation unit 16 identifies prescription drugs for which prescription quantities exceeding a predetermined threshold have been prescribed over the past 5 years, according to a predetermined program. The procurement information estimation unit 16 may identify the identified prescription drugs as prescription drugs to be purchased in bulk. The procurement information estimation unit 16 may specify the prescription volume to be purchased in bulk for the next year as the prescription volume calculated using a predetermined calculation formula, such as 80% of the prescription volume of prescription drugs identified as targets for bulk purchase. The identification of prescription drugs to be purchased in bulk and the calculation of the prescription volume for the next unit period (1 year) may be performed using any calculation formula. For example, if the total prescription volume of prescription drugs identified as targets for bulk purchase at all pharmacies 4 over the past 5 years is on an increasing trend, the procurement information estimation unit 16 may multiply the prescription volume of the previous year by the average annual increase rate to identify the prescription volume of prescription drugs identified as targets for bulk purchase for the next year, and then specify that prescription volume as the amount to be purchased in bulk.

[0041] The procurement information estimation unit 16 may estimate the types and quantities of prescription drugs to be purchased in bulk 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 quantity of each prescription drug prescribed by all pharmacies 4 in past analysis periods and analysis intervals (one or more analysis periods and analysis intervals) and the prescription drugs and their quantities (bulk purchase quantities) that have been identified as being subject to bulk purchase in the next unit period. Alternatively, the estimation model may be a learning model generated by machine learning the relationship between the information for each past period and interval stored in the first prescription content DB 53, second prescription content DB 54, and third prescription content DB 55 and the types and quantities of prescription drugs to be purchased in bulk that have been identified based on the information for those periods and intervals. The procurement information estimation unit 16 inputs the prescription quantity of each prescription drug dispensed by all pharmacies 4 in past analysis periods and analysis intervals (1-year units over the past 5 years) into the estimation model. As a result, the procurement information estimation unit 16 obtains the prescription drugs and their quantities (bulk purchase quantities) that have been identified as being subject to bulk purchase in the next unit period as a calculation result of the estimation model. This process is an example of how the procurement information estimation unit 16 estimates the type and quantity of prescription drugs to be procured in bulk, based on a learning model generated based on past prescription records and statistical information on prescription content related to prescription drugs.

[0042] The estimation model may be machine-trained to include seasonal index conditions (temperature, humidity, number of typhoons, pollen count, etc. for each unit period) in past analysis periods and analysis intervals (one or more analysis periods and analysis intervals). When the procurement information estimation unit 16 estimates the type and quantity of prescription drugs to be purchased in bulk, it may input the predicted seasonal index conditions for the next unit period into the estimation model and obtain from the estimation model the prescription drugs and their quantities (bulk purchase quantities) that have been identified as requiring bulk purchase in the next unit period.

[0043] The procurement information estimation unit 16 may estimate the type and quantity of prescription drugs to be purchased in bulk using other methods. For example, the procurement information estimation unit 16 may compare drug prices for prescription drugs with the same generic name and the same potency in drug units, and confirm the cost reduction effect associated with replacing them with the cheapest drug unit. Specifically, the procurement information estimation unit 16 may compare drug prices for prescription drugs with the same drug unit and calculate the prescription quantity when replaced with the cheapest drug unit. Then, the procurement information estimation unit 16 may estimate the type and quantity of prescription drugs to be purchased in bulk, similar to the above, based on the prescription quantity over past analysis periods and analysis intervals when replaced with the cheapest drug unit. The procurement information estimation unit 16 may estimate the type and quantity of prescription drugs to be purchased in bulk using any processing method.

[0044] The procurement information estimation unit 16 may also be a processing unit that generates and outputs information for the administrator to analyze and identify the types and quantities of prescription drugs that are subject to bulk procurement. For example, the procurement information estimation unit 16 may generate and output graphs of statistical information obtained from the first prescription content DB 53, second prescription content DB 54, and third prescription content DB 55 based on past analysis periods and analysis intervals, and as a result, input information on the types and quantities of prescription drugs that the administrator has estimated to be subject to bulk procurement in the next predetermined future period.

[0045] The procurement information estimation unit 16 outputs the types and quantities of prescription drugs to be purchased in bulk during the next unit period to the pharmaceutical company management unit 17. The pharmaceutical company management unit 17 may send the types and quantities of prescription drugs to be purchased in bulk to the pharmaceutical company terminals 50 of multiple pharmaceutical companies 5 and perform bidding processing. The management device 10 includes 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 during the next unit period and perform bidding processing based on access from the pharmaceutical company terminals 50. The pharmaceutical company management unit 17 may place orders, purchase processing, and payment processing with the pharmaceutical companies 5 that are the bulk purchase destinations for the prescription drugs identified as a result of the bidding processing. The pharmacy management unit 18 may identify a supplier terminal 60 based on the pharmaceutical companies 5 identified as a result of the bidding processing and instruct that supplier terminal 60 to distribute the drugs to the dispensing pharmacy 4. In this case, the pharmacy management department 18 calculates the allocation amount to be distributed to each dispensing pharmacy 4 based on the type and quantity of prescription drugs to be purchased in bulk, and the proportion of prescriptions in each dispensing pharmacy 4 over past analysis periods and analysis intervals. The pharmacy management department 18 may output an allocation processing instruction, including the allocation amount to be distributed to each dispensing pharmacy 4, to the supplier terminal 60. The supplier managing the supplier terminal 60 then delivers the prescription drugs to each dispensing pharmacy 4 based on the allocated amount.

[0046] As described above, one embodiment of this disclosure has been explained. According to the processing of the direct drug benefit management system 100 and management device 10 described above, statistical information on the prescription content for each of the multiple prescription drugs calculated based on information related to the prescription drugs is obtained, and the types and quantities of prescription drugs to be purchased in bulk are estimated by analyzing the prescription content. As a result, by having the insurer 1 purchase prescription drugs in bulk that it has identified as being purchased in bulk, the costs that many dispensing pharmacies 4 would otherwise incur by purchasing prescription drugs individually can be reduced. Furthermore, by having the insurer 1 identify drugs that are prescribed in large quantities, purchase those drugs in bulk, and manage the allocation of drugs to each dispensing pharmacy 4, the costs related to prescription drugs prescribed to insured persons 2 can be reduced, thereby reducing the cost burden on the government and insured persons 2, etc., related to medical care, and the labor of drug procurement at dispensing pharmacies 4.

[0047] The procurement information estimation unit 16 may further estimate the timing of procurement for prescription drugs to be procured in bulk based on statistical information of prescription content. For example, the procurement information estimation unit 16 may identify the timing immediately before an increase in prescription volume as the procurement timing, based on the increase or decrease in prescription volume for each prescription drug at all dispensing pharmacies 4 for each past 3-month unit period. The timing immediately before an increase in prescription volume may be identified as the timing when the prescription volume for each analysis interval is higher by a predetermined percentage than the prescription volume for the previous analysis interval (e.g., March of the previous year) based on past statistical information, and the timing immediately before March of the following year may be identified as the procurement timing in January or February of that year. Alternatively, when seasonal index conditions (temperature, humidity, number of typhoons, pollen count, etc. for each unit period) for the previous unit period (1 month) are input, prescription drugs whose prescription volume increases according to those seasonal index conditions may be identified and identified as the procurement timing for the next unit period (1 month). This makes it possible to identify procurement timings in response to increases or decreases in prescription drugs that occur according to seasonal events. The procurement information estimation unit 16 may identify procurement timings in any way based on past statistical information and algorithms.

[0048] The prescription information acquisition unit 12 may acquire information about the prescribed medications included in the medical fee statement for each insured person 2, as well as prescription timing (date and time of prescription, number of prescriptions per unit period), etc. The guidance information generation unit 19 may then generate guidance information regarding the use of the prescribed medications based on the information about the prescribed medications and prescription timing for each insured person 2. The guidance information can be any information related to the use of the prescribed medications. The guidance information generation process may be carried out according to a predetermined program. For example, a guidance document template determined according to the number of prescriptions per unit period included in the prescription timing may be acquired from the database, and guidance information including that guidance document 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 claim data stored in the insurer's total claim DB 51 and the identifier of the dispensing pharmacy 4. The guidance information generation unit 19 then transmits the guidance information generated 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 embodiments, the present disclosure is not limited to the embodiments described above.

[0050] Some or all of the above embodiments may also be described as follows, but are not limited to the following:

[0051] (Note 1) A prescription information acquisition method that obtains information related to prescription drugs included in medical fee statements for each of multiple prescription drugs, A prescription content acquisition means for acquiring statistical information on the prescription content of each of the multiple prescription drugs calculated based on information related to the aforementioned prescription drugs, A procurement information estimation means that analyzes the aforementioned prescription details to estimate the type and quantity of prescription drugs to be purchased in bulk, A direct drug benefit management system provided by insurers.

[0052] (Note 2) A prescription content calculation means that calculates statistical information on the prescription content for each of the plurality of prescription drugs based on information related to the prescription drugs, A direct drug benefit management system provided by the insurer as described in Appendix 2, comprising the above.

[0053] (Note 3) The aforementioned procurement information estimation means is: Based on a learning model generated from past prescription records and statistical information on prescription details related to the prescribed drugs, the type and quantity of prescribed drugs to be purchased in bulk are estimated. A direct drug benefit management system implemented by the insurer as described in Appendix 3.

[0054] (Note 4) The prescription information acquisition means acquires information related to the prescribed drugs included in the medical fee statements handled by multiple pharmacies for each of the multiple prescribed drugs, The above prescription details show the relationship between the type and quantity of each prescribed drug. The procurement information estimation means estimates the type and quantity of prescription drugs to be provided to multiple pharmacies and subject to bulk procurement, based on statistical information of the prescription details for each of the multiple prescription drugs prescribed at multiple pharmacies. A direct drug benefit management system implemented by the insurer as described in Appendix 1.

[0055] (Note 5) The procurement information estimation means further estimates the timing of procurement of prescription drugs to be procured in bulk based on the statistical information of the prescription contents. A direct drug benefit management system implemented by the insurer as described in Appendix 4.

[0056] (Note 6) The prescription information acquisition means acquires information about the prescribed medications included in the medical fee statement for each insured person, as well as the timing of the prescription. A guidance information generation means generates guidance information regarding the use of the prescribed medications based on information about the prescribed medications for each of the insured persons and the timing of the prescriptions. A direct drug benefit management system provided by the insurer described in Appendix 1, comprising the above.

[0057] (Note 7) A prescription information acquisition method that obtains information related to prescription drugs included in medical fee statements for each of multiple prescription drugs, A prescription content acquisition means for acquiring statistical information on the prescription content of each of the multiple prescription drugs calculated based on information related to the aforementioned prescription drugs, A procurement information estimation means that analyzes the aforementioned prescription details to estimate the type and quantity of prescription drugs to be purchased in bulk, An information processing device equipped with the following features.

[0058] (Note 8) Information related to the prescribed medications included in the medical fee statement is obtained for each of the multiple prescribed medications. Based on the information related to the aforementioned prescription drugs, statistical information on the prescription content for each of the multiple prescription drugs is obtained. By analyzing the aforementioned prescription details, the types and quantities of prescription drugs to be purchased in bulk are estimated. Information processing methods.

[0059] (Note 9) Computers, A prescription information acquisition method that obtains information related to prescription drugs included in medical fee statements for each of multiple prescription drugs. A prescription content acquisition means for acquiring statistical information on the prescription content of each of the multiple prescription drugs calculated based on information related to the aforementioned prescription drugs, Procurement information estimation means for estimating the type and quantity of prescription drugs to be purchased in bulk by analyzing the aforementioned prescription details, A program that makes it function as such. [Explanation of symbols]

[0060] 10...Management device 11. Control Unit 12. Prescription Information Acquisition Department 13. Prescription Content Calculation Department 14. Database Generation Unit 15. Prescription Information Acquisition Department 16. Procurement Information Estimation Department 17. Pharmaceutical Company Management 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 terminals 100... Direct drug distribution management system

Claims

1. A means for obtaining detailed information to acquire medical fee statement information managed by the insurer, A prescription information acquisition means for acquiring information related to prescription drugs included in the medical fee statement information for each of multiple prescription drugs, A prescription content acquisition means for acquiring statistical information on the prescription content for each of the multiple prescription drugs for each insured person corresponding to the insurer for each unit period, calculated based on information related to the prescription drugs, A procurement information estimation means that analyzes the aforementioned prescription details and estimates the type and quantity of prescription drugs to be prescribed to insured persons corresponding to the insurer in a predetermined future unit period, and which are subject to bulk procurement. A direct drug benefit management system provided by insurers.

2. A prescription content calculation means that calculates statistical information on the prescription content for each of the plurality of prescription drugs based on information related to the prescription drugs, A direct drug benefit management system by an insurer according to claim 1, comprising:

3. The aforementioned procurement information estimation means is: Based on a learning model generated from past prescription records and statistical information on prescription details related to the prescribed drugs, the type and quantity of prescribed drugs to be purchased in bulk are estimated. A direct drug benefit management system by an insurer as described in claim 2.

4. The prescription information acquisition means acquires information related to the prescribed drugs contained in the medical fee statement information handled by multiple pharmacies for each of the multiple prescribed drugs, The above prescription details show the relationship between the type and quantity of each prescribed drug. The procurement information estimation means estimates the type and quantity of prescription drugs to be provided to multiple pharmacies and subject to bulk procurement, based on statistical information of the prescription details for each of the multiple prescription drugs prescribed at multiple pharmacies. A direct drug benefit management system by an insurer as described in claim 1.

5. The procurement information estimation means further estimates the timing of procurement of prescription drugs to be procured in bulk based on the statistical information of the prescription contents. A direct drug benefit management system by an insurer as described in claim 4.

6. The prescription information acquisition means acquires information about prescribed drugs included in the medical fee statement information for each insured person, as well as the timing of prescription, A guidance information generation means generates guidance information regarding the use of the prescribed medications based on information about the prescribed medications for each of the insured persons and the timing of the prescriptions. A direct drug benefit management system by an insurer according to claim 1, comprising:

7. A means for obtaining detailed information to acquire medical fee statement information managed by the insurer, A prescription information acquisition means for acquiring information related to prescription drugs included in the medical fee statement information for each of multiple prescription drugs, A prescription content acquisition means for acquiring statistical information on the prescription content for each of the multiple prescription drugs for each insured person corresponding to the insurer for each unit period, calculated based on information related to the prescription drugs, A procurement information estimation means that analyzes the aforementioned prescription details and estimates the type and quantity of prescription drugs to be prescribed to insured persons corresponding to the insurer in a predetermined future unit period, and which are subject to bulk procurement. An information processing device equipped with the following features.

8. We obtain medical fee statement information managed by the insurer, Information related to the prescribed drugs included in the aforementioned medical fee statement information is obtained for each of the multiple prescribed drugs. Based on the information related to the prescribed drugs, statistical information on the prescription content for each of the multiple prescribed drugs for each insured person corresponding to the insurer is obtained for each unit period. By analyzing the aforementioned prescription details, the types and quantities of prescription drugs to be prescribed to insured persons corresponding to the aforementioned insurer during a predetermined future unit period, and which are subject to bulk purchasing, are estimated. Information processing methods.

9. Computers, A means for obtaining detailed information to acquire medical fee statement information managed by the insurer. Prescription information acquisition means for acquiring information related to prescription drugs included in the medical fee statement information for each of multiple prescription drugs, Prescription content acquisition means for acquiring statistical information on the prescription content for each of the multiple prescription drugs for each unit period relating to an insured person corresponding to the insurer, calculated based on information relating to the aforementioned prescription drugs. Procurement information estimation means for estimating the type and quantity of prescription drugs to be prescribed to insured persons corresponding to the insurer in a predetermined future unit period, and which are subject to bulk procurement, by analyzing the aforementioned prescription content. A program that makes it function as such.

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