Accumulation Records for Prescription Rebate Cap Enforcement
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Solution Overview
Problem
Integrating multiple sub-systems for prescription drug pricing and rebate distribution within a service provider computer leads to inefficiencies due to differing calculation methods, contractual agreements, and communication interfaces, resulting in excessive network transactions and resource consumption.
Innovation Solution
A service provider computer generates aggregated quantities from multiple sub-systems, modifies rebate calculations in real-time to enforce manufacturer caps, and reduces unnecessary transactions by selectively invoking sub-systems.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Adaptability or versatility
If multiple sub-systems are integrated to provide additional functionality and reach more patients, then the coverage and functionality are improved, but the number of network transactions and resource consumption increase excessively
Solution Approach 1:
The patent combines multiple sub-systems into a single integrated system that processes prescription transactions through one unified interface. Instead of maintaining separate communication channels with each sub-system, the integrated system consolidates their functionality, reducing the number of network transactions while preserving the ability to access multiple rebate programs and pricing mechanisms.
Solution Approach 2:
The integrated system performs multiple functions that previously required separate sub-systems, including processing prescription transactions, calculating rebates from multiple manufacturers, enforcing caps, and managing accumulation records. This multi-functional approach eliminates the need for separate dedicated systems while maintaining comprehensive coverage.
2Reliability
If each sub-system independently enforces manufacturer caps on rebate amounts, then each sub-system operates autonomously and reliably, but the total rebate applied may exceed the manufacturer cap
Solution Approach 1:
The integrated system implements feedback mechanisms that track the cumulative rebate amount applied across all manufacturers for each prescription transaction. Before applying a rebate from any manufacturer, the system checks the current accumulated total against the manufacturer's cap and adjusts the rebate amount accordingly, ensuring that the total never exceeds the cap while maintaining autonomous operation of individual manufacturer calculations.
3Measurement precision
If real-time rebate calculations are performed for each prescription transaction, then pricing accuracy is improved, but processing time and computational resources increase
Solution Approach 1:
The system performs preliminary actions by pre-calculating and storing accumulation records for each manufacturer, tracking the total rebate amounts already applied. When a new prescription transaction arrives, the system retrieves these pre-computed accumulation records and uses them to quickly determine the appropriate rebate amount, maintaining real-time pricing accuracy while significantly reducing processing time compared to calculating everything from scratch.
Data Source
AI summary
A method, apparatus and computer program product are provided for utilizing accumulation records to reduce a number of transactions occurring in a network. Aggregated quantities are calculated from at least a first quantity from a first sub-system and a second quantity from the second sub-system. Preliminary amounts may be reduced based on cap amounts less the aggregated quantity, and transmission of messages to certain sub-systems may be precluded. Accumulation records may be maintained by a service provider computer on an ongoing basis. The service provider computer forwards responses that reflect a reduced preliminary amount to a requesting computer that initiated a response.