Blister Packaging Adjudication for Prescription Drug Refills
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Solution Overview
Problem
Patients often fail to adhere to their prescription drug regimens due to forgetfulness, inconvenience, or delays in refilling prescriptions, leading to adverse health effects.
Innovation Solution
A system and method for prescription drug packaging that includes a pharmacy device and a benefit manager device communicating over a network to determine if a prescription drug should be filled with blister packaging based on adherence criteria, improving patient adherence by ensuring timely refills and reducing the need for in-person visits.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If patients refill prescriptions manually at the pharmacy, then they can obtain their medication, but they often miss doses due to forgetfulness, inconvenience, or delays in refilling
Solution Approach 1:
The system performs preliminary actions by automatically identifying when a prescription is nearing depletion and initiating the refill process before the patient needs to manually visit the pharmacy. The adjudication system proactively determines refill eligibility and notifies patients, eliminating the time loss associated with manual refilling and improving adherence through timely automated intervention.
2Reliability
If patients schedule office visits for prescription renewal, then they can obtain continued therapy, but scheduling conflicts and delays result in prolonged nonadherence
Solution Approach 1:
The system extracts the refill authorization function from the required office visit process. By enabling automated adjudication of refill requests through the network system, patients no longer need to schedule in-person appointments to renew prescriptions. The system handles the entire refill authorization process electronically, eliminating the time-consuming office visit requirement while ensuring continued therapy.
3Reliability
If pharmacies require new written prescriptions for refills, then they can ensure proper medical approval, but the required doctor visit causes delays and scheduling conflicts
Solution Approach 1:
The system introduces an intermediary electronic adjudication process between the patient's refill request and the pharmacy's fulfillment. The adjudication system electronically verifies medical approval criteria, prescription validity, and refill eligibility without requiring a new written prescription or doctor visit. This intermediary process maintains the reliability of medical approval while simplifying the overall refill process by eliminating the need for in-person doctor appointments.
Data Source
AI summary
Systems and methods for prescription drug packaging are described. In some embodiments, a determination that a member of a pharmacy benefit plan has had a plurality of prescription drugs previously filled is made. An adjudication request for a prescription drug prescribed for the member is received. The adjudication request is based on a fulfillment request to fill the prescription drug. A determination that a blister packaging criterion has been met may be made based on a drug type of the prescription drug and a determination that the member has had the plurality of prescription drugs that have previously been filled. A blister fill instruction is transmitted based on receipt of the adjudication request and a determination that the blister packaging criterion has been met, wherein the blister fill instruction reflects that a pharmacy is to fill the prescription drug utilizing blister packaging. Additional methods and systems are disclosed.