Prescription Drug Plan Simulation System for Spend Analysis
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Solution Overview
Problem
Current manual analysis of prescription drug spending is error-prone, costly, and limited in functionality, making it difficult for employers to effectively manage and reduce prescription drug trends in their plans.
Innovation Solution
A computer-implemented system and method for simulating changes to prescription drug plans, which analyzes spend and trend data to identify deviations, determine primary components of spending, and provide options for improvement, using financial and clinical models to project the impact of changes.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If manual analysis of prescription drug claims data is performed, then analysis can be conducted, but the process becomes error-prone, costly, and difficult
Solution Approach 1:
The patent replaces manual mechanical analysis with an automated computerized system that processes prescription drug claims data. The system uses software algorithms to automatically analyze spend and trend data, eliminating human error while reducing complexity through automation. The computerized platform performs calculations and generates insights without requiring manual intervention in the analysis process.
2Measurement precision
If manual analysis of prescription drug claims data is performed, then analysis can be conducted, but the process becomes costly
Solution Approach 1:
The system enables self-service analysis where the computerized platform automatically processes claims data without requiring expensive manual intervention. The automated system performs spend and trend analysis, identifies deviations from targets, and provides recommendations independently, eliminating the need for costly manual analysis while maintaining or improving accuracy through consistent algorithmic processing.
3Adaptability or versatility
If manual analysis of prescription drug claims data is performed, then analysis can be conducted, but functionality remains limited
Solution Approach 1:
The patent implements a universal computerized platform that performs multiple analysis functions within a single system. The platform can analyze spend data, trend data, deviations from targets, and provide recommendations across different prescription drug plan scenarios. This multi-functional approach increases adaptability while the automated nature of the system manages complexity through standardized processing routines.
4Productivity
If automated system is implemented to analyze prescription drug spending, then accuracy and efficiency improve, but system complexity increases
Solution Approach 1:
The patent segments the analysis system into distinct functional modules: data retrieval components that collect claims data, analysis components that process spend and trend information, deviation detection components that compare against targets, and recommendation components that generate insights. This segmentation improves productivity by allowing parallel processing while managing complexity through modular design where each component has a specific, well-defined function.
Data Source
AI summary
Systems and methods for simulating a change to a prescription drug plan may be provided. In response to receiving a request to simulate the change to the prescription drug plan, a prescription drug spend and/or trend application may retrieve data related to the prescription drug plan from a database. A model that includes a plurality of calculations to simulate the change may be applied to the retrieved data A user computing device may be provided with an indication of an impact on the prescription drug plan responsive to the at least one change based at least in part on the application of the model to the retrieved data. The modeling of the change may be related, for example, to an option to reduce spend and/or trend as determined by the spend and/or trend application.