PBM Data and Signal Processing for Transparent Prescription Pricing
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Solution Overview
Problem
Consumers and pharmacy benefit providers face increasing prescription drug costs due to opaque pricing processes and lack of transparency in rebate negotiations between Pharmacy Benefit Managers (PBMs) and pharmacies, resulting in higher consumer prices and missed savings opportunities.
Innovation Solution
An Alternate Pharmacy Benefit Manager (APBM) system that deduces Pharmacy Reimbursement Amounts and provides consumers with transparent pricing information, offering rewards and guaranteed prices by inserting itself as an alternative middleman between PBPs and pharmacies, allowing consumers to fill prescriptions at lower-cost pharmacies.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Loss of information
If traditional PBM systems are used to negotiate rebates and discounts between pharmacies and drug manufacturers, then pharmacy benefit management functions are performed, but pricing transparency is lost and consumer prices increase
Solution Approach 1:
The patent introduces an intermediary system (electronic prescription card system with unique identifiers) that mediates between consumers, pharmacies, and PBMs. This intermediary captures and transmits pricing information through the ecosystem, enabling transparency without eliminating the traditional rebate negotiation process. The system acts as a transparent middle layer that reveals pricing data while maintaining the underlying commercial relationships.
2Adaptability or versatility
If consumers are provided with transparent pricing information and alternative pharmacy options, then consumer choice and potential cost savings increase, but system complexity increases
Solution Approach 1:
The patent segments the prescription fulfillment process into distinct components: electronic prescription cards with unique identifiers, pharmacy registration systems, consumer interface systems, and PBM integration points. Each segment handles specific functions independently, allowing consumers to access pricing information and choose pharmacies without requiring complete system redesign. The segmentation enables incremental implementation and reduces overall system complexity.
Solution Approach 2:
The electronic prescription card system serves multiple functions: it identifies the consumer, tracks prescription information, provides pricing transparency, enables pharmacy selection, and interfaces with existing PBM systems. This multi-functional approach consolidates what could be multiple separate systems into a single universal platform, reducing complexity while expanding consumer choice capabilities.
3Loss of energy
If rebate savings from drug manufacturers are not passed on to consumers through traditional PBM systems, then PBM spreads are maintained, but consumer costs increase
Solution Approach 1:
The patent implements feedback mechanisms where pricing information flows back to consumers through the electronic prescription card system. Rebate savings and actual pricing data are captured during the prescription fulfillment process and fed back to consumers, enabling them to see where savings occur and how they benefit. This feedback loop ensures that rebate savings are visible and can be directed to consumers through transparent pricing displays and consumer-facing interfaces.
Data Source
AI summary
In accordance with some embodiments, an alternative system for processing of signals for use on a PBM or other healthcare network is described. In accordance with some embodiments, the system obtains a data packet defining at least one parameter of at least one pharmaceutical prescription and/or pharmacy, and identifies one or more data objects in the data packet to be swapped out within the at least one parameter. The system may then output one or more offers to a user via a dynamically updated graphical user interface of a software app, at least one of the offers defining a reward, and generating a file using the swapped out data packet upon detecting a signal indicating acceptance.