Message Routing System for Real-Time Prescription Pricing
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Solution Overview
Problem
Pharmacists face inefficiencies in determining medication costs and formulary alternatives without generating multiple billing transactions, leading to workflow delays and resource consumption, as they lack direct access to patient insurance carrier or cash pricing information, and current systems do not allow for real-time pricing inquiries before prescriber approval.
Innovation Solution
A system that parses electronic messages to determine evaluation systems, generates alternative evaluation messages with different product identifiers or sends them to secondary evaluation systems, allowing real-time transmission of responses to requesting computers, enabling pharmacists to select and modify refill requests with updated pricing information before prescriber approval.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Loss of information
If pharmacists generate multiple billing transactions to obtain pricing information from different evaluation systems, then they can access comprehensive pricing data, but this increases workflow complexity and resource consumption
Solution Approach 1:
The patent introduces an intermediary system (the message routing system with evaluation message generation capability) that mediates between the pharmacist's single transaction and multiple evaluation systems. This intermediary automatically generates and routes appropriate evaluation messages to multiple systems, consolidates responses, and presents unified pricing information to the pharmacist, thereby eliminating the need for pharmacists to manually initiate multiple billing transactions while maintaining access to comprehensive pricing data from formulary and cash pricing systems
2Loss of time
If pharmacists wait for prescriber approval before obtaining pricing information, then system resources are conserved, but real-time pricing transparency to patients is delayed
Solution Approach 1:
The patent implements preliminary action by enabling the system to generate and process evaluation messages for pricing information at the time of the initial refill request, before prescriber approval is obtained. The system proactively queries multiple evaluation systems, obtains pricing data, and prepares cost information for patient display during the approval workflow, rather than waiting until after approval. This preliminary retrieval of pricing information provides real-time transparency to patients while the prescriber review is ongoing, without requiring additional resource-intensive transactions later
3Loss of information
If the system polls multiple evaluation systems for pricing information, then comprehensive pricing data is obtained, but resource consumption and processing time increase
Solution Approach 1:
The patent applies universality by designing a multi-functional evaluation message that can serve multiple purposes and interface with multiple evaluation systems through a unified mechanism. The single evaluation message structure is universally applicable to both formulary evaluation systems and cash pricing systems, allowing the system to query diverse sources through one standardized interface. This universal approach consolidates what would otherwise require multiple different transaction types into a single efficient operation, maintaining comprehensive pricing data retrieval while improving processing efficiency
Data Source
AI summary
A method, apparatus and computer program product are provided for generating a first evaluation message and an alternative evaluation messages in response to an electronic message from a requesting computer. Multiple responses, including a first evaluation message response and at least one alternative evaluation message response are returned to the requesting computer. A user can select one of the multiple responses for further forwarding to a verification system via a service provider computer. The service provider computer further facilitates verification of the selected response, such as an alternative evaluation system, via the verification system. The system enables generation of multiple pricing inquiries for alternative therapy and/or via different pricing schemas, to be imitated by a pharmacy computer upon a patient requesting a prescription refill.