Parallel Pricing Subsystem for Pharmacy Benefit Managers
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Solution Overview
Problem
Pharmacy benefit managers face challenges in managing pricing guarantees for prescription drugs, as they often struggle to achieve the discounted prices promised to clients, leading to potential reimbursement gaps and increased costs for clients and members.
Innovation Solution
The system and method for managing pricing guarantees involve a pricing subsystem that compares actual discounts with target guarantees, allowing for modifications to the pricing schedule to ensure that discounts meet or exceed the promised levels, thereby reducing the financial burden on clients and members by adjusting the amount covered by the drug benefit program.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If pharmacy benefit managers use traditional sequential processing for pricing schedule modifications and claim adjudications, then system simplicity is maintained, but business operations experience interruptions and delays
Solution Approach 1:
The patent divides the processing system into separate processing threads or processes that can operate independently and simultaneously. Claim adjudications, pricing schedule modifications, and report generations are segmented into distinct operational units that execute in parallel, eliminating sequential bottlenecks and ensuring business continuity during pricing updates.
Solution Approach 2:
The patent combines multiple processing functions into a unified parallel processing framework where different operations (claim adjudication, pricing modification, report generation) run concurrently on the same system infrastructure, achieving both operational continuity and resource efficiency.
2Reliability
If pharmacy benefit managers implement parallel processing for pricing schedule modifications and claim adjudications, then business operation continuity is maintained, but system complexity increases
Solution Approach 1:
The patent introduces intermediary mechanisms such as pricing schedule queues and processing coordinators that manage the interaction between parallel processes. These intermediaries coordinate data flow and synchronization between claim adjudication threads and pricing modification threads, ensuring reliable operation continuity while managing system complexity through structured communication protocols.
3Measurement precision
If pharmacy benefit managers process pricing guarantees in real-time, then pricing accuracy is improved, but processing time increases
Solution Approach 1:
The patent performs preliminary actions by pre-calculating and storing pricing schedule modifications in queues before they are needed for claim adjudication. Pricing guarantees are evaluated and prepared in advance, allowing real-time pricing accuracy during claim processing without adding computational overhead or delays to the actual adjudication time.
Data Source
AI summary
Methods and systems for managing pricing guarantees for prescription drugs are described. In one embodiment, a target prescription drug discount guarantee associated with a pharmacy benefit manager client is accessed. A prescription drug discount associated with a plurality of prescription drug claims associated with the pharmacy benefit manager client is calculated to obtain a calculated prescription drug discount. A difference between the target prescription drug discount guarantee and the calculated prescription drug discount is determined. A prescription drug pricing schedule associated with the pharmacy benefit manager client is modified based on the difference between the target discount guarantee and the prescription drug discount to create a modified prescription drug pricing schedule. Other methods and systems are described.