Prescription Refill Alignment System with Cost Determination
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Solution Overview
Problem
Customers face inconvenience and potential health issues due to varying refill dates for multiple prescriptions, which existing solutions like mail order and call-center services do not fully address, and are further complicated by insurance and regulatory rules.
Innovation Solution
A prescription alignment system that uses a network of pharmacy workstations and central processing systems to align refill dates by adjusting medication quantities, determining alignment dates, and calculating costs through a cost determination module, allowing for options like pro-rated copays, tiered copays, and alignment fees.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Ease of operation
If prescriptions are filled on different dates according to individual prescription requirements, then each prescription can be filled according to its specific needs, but customers face inconvenience and potential health issues due to varying refill dates
Solution Approach 1:
The system performs preliminary calculations to determine an alignment date before actual prescription filling. By calculating the alignment date in advance based on prescription duration and refill schedules, the system enables customers to know all refill dates beforehand, improving convenience while ensuring compliance through pre-planned alignment
2Ease of operation
If medication quantities are adjusted to align refill dates, then refill dates can be synchronized across multiple prescriptions, but this requires modified quantities of medication which may not match original prescription specifications
Solution Approach 1:
The system applies partial adjustment to medication quantities only when necessary for alignment, rather than uniformly adjusting all prescriptions. By calculating the minimal quantity modification needed to achieve date alignment, the system maintains prescription accuracy while enabling synchronization, using excessive action only when required to meet alignment goals
3Ease of operation
If a system aligns multiple prescriptions by modifying quantities and calculating alignment dates, then refill dates can be synchronized, but this increases system complexity involving workstations, central processing, and cost determination modules
Solution Approach 1:
The system divides the prescription alignment function into separate modular components: pharmacy workstations for data collection and initiation, central processing system for alignment date calculation and coordination, and cost determination module for financial calculations. This segmentation allows each component to perform its specific function independently, reducing overall system complexity while maintaining alignment capability
4Productivity
If alignment fees or adjusted copay structures are implemented to cover alignment costs, then the system can sustain alignment operations, but this increases cost complexity with multiple pricing options including pro-rated copays, tiered copays, and alignment fees
Solution Approach 1:
The system implements flexible cost parameters including pro-rated copays based on alignment date timing, tiered copay structures for different alignment scenarios, and optional alignment fees. By changing cost parameters rather than creating separate systems, the system achieves sustainability while managing cost complexity through parameter-based adjustments to existing pricing mechanisms
Data Source
AI summary
A system and method facilitate alignment of refill dates associated with a plurality of prescriptions, and determine the cost to the customer for the alignment of the plurality of prescriptions. The system may determine the cost to the customer by evaluating one or more of the number of prescriptions aligned, the types of medications prescribed by the aligned prescriptions, the quantity of medication supplied in any intermediate fills between the last adjudication date and the alignment adjudication date, the particular medications prescribed by the aligned prescriptions, and the number of prescriptions aligned. The system may also evaluate one or more rules or contracts related to one or more third-party payors in determining the cost to the customer for alignment.