公开(公告)号：WO2005116894A2

公开(公告)日：2005-12-08

申请号：PCT/US2005016913

申请日：2005-05-13

Applicant: HUMANA INC ,  AUGSPURGER KRISTEN R ,  STEPHENS SARAH A ,  KARRER MICHAEL A ,  VINSON KENNON L ,  FLINCHUM MARK A ,  KALLIK INESSA ,  ELIZABETH MEGAN K ,  WARREN ELIZABETH M ,  FLEMING WILLIAM K ,  LORD JONATHAN T

Inventor： AUGSPURGER KRISTEN R ,  STEPHENS SARAH A ,  KARRER MICHAEL A ,  VINSON KENNON L ,  FLINCHUM MARK A ,  KALLIK INESSA ,  ELIZABETH MEGAN K ,  WARREN ELIZABETH M ,  FLEMING WILLIAM K ,  LORD JONATHAN T

IPC: G06F19/00 ,  G06Q30/00 ,  G06F17/60

CPC classification number: G06F19/328 ,  G06Q10/087 ,  G06Q30/08 ,  G06Q50/22

Abstract: A Pharmacy Benefits Calculator reads in an insured's prior pharmacy claims history and then calculates said insured's anticipated out-of-pocket costs for one or more pharmacy benefits plans that said insured is eligible to enroll in. Provision is made for an insured to modify their anticipated future pharmacy needs. Provision is also made for an insured to compare their out-of-pocket costs for different alternative drugs, said alternative drugs providing comparable therapeutic benefits. Provision also is made for an insured to substitute a lower cost generic equivalent for a brand drug, when available. Another provision is made for an insured to choose to price drugs at a retail pharmacy store or a mail order pharmacy and determine cost differences. The pricing available from said retail pharmacy store may be based on a price negotiated by an insurance company offering said pharmacy benefits plans.

Abstract translation: 药房津贴计算器读入被保险人以前的药房索赔记录，然后计算被保险人有资格参加的一个或多个药房福利计划的所有被保险人的预期自付费用。为被保险人提供修改预期 未来的药学需求。 还规定，被保险人可以比较不同替代药物的自付费用，提供替代药物提供可比较的治疗益处。 也可以为被保险人提供替代品牌药物的较低成本通用等效物。 还有一项规定是为被保险人选择在零售药店或邮寄药房进行药物定价，并确定成本差异。 来自所述零售药房的定价可以基于由提供所述药房福利计划的保险公司商定的价格。

公开(公告)号：WO2005116894A3

公开(公告)日：2005-12-08

申请号：PCT/US2005/016913

申请日：2005-05-13

Applicant: HUMANA INC. ,  AUGSPURGER, Kristen, R. ,  STEPHENS, Sarah, A. ,  KARRER, Michael, A. ,  VINSON, Kennon, L. ,  FLINCHUM, Mark, A. ,  KALLIK, Inessa ,  ELIZABETH, Megan, K. ,  WARREN, Elizabeth, M. ,  FLEMING, William, K. ,  LORD, Jonathan, T.

Inventor： AUGSPURGER, Kristen, R. ,  STEPHENS, Sarah, A. ,  KARRER, Michael, A. ,  VINSON, Kennon, L. ,  FLINCHUM, Mark, A. ,  KALLIK, Inessa ,  ELIZABETH, Megan, K. ,  WARREN, Elizabeth, M. ,  FLEMING, William, K. ,  LORD, Jonathan, T.

IPC: G06Q10/00 ,  G06Q40/00

Abstract: A Pharmacy Benefits Calculator reads in an insured's prior pharmacy claims history and then calculates said insured's anticipated out-of-pocket costs for one or more pharmacy benefits plans that said insured is eligible to enroll in. Provision is made for an insured to modify their anticipated future pharmacy needs. Provision is also made for an insured to compare their out-of-pocket costs for different alternative drugs, said alternative drugs providing comparable therapeutic benefits. Provision also is made for an insured to substitute a lower cost generic equivalent for a brand drug, when available. Another provision is made for an insured to choose to price drugs at a retail pharmacy store or a mail order pharmacy and determine cost differences. The pricing available from said retail pharmacy store may be based on a price negotiated by an insurance company offering said pharmacy benefits plans.

公开(公告)号：WO2005109279A2

公开(公告)日：2005-11-17

申请号：PCT/US2005/014723

申请日：2005-05-02

Applicant: HUMANA, INC. ,  WARREN, Elizabeth, M. ,  SANDMAN, Timothy, B. ,  HUTTI, Jacob, M. ,  LORD, Jonathan, T. ,  WHITWORTH, Julie, E. ,  SHAW, Elizabeth, M. ,  FLEMING, William, K. ,  WATSON, HEIDARI, Teresa, L.

Inventor： WARREN, Elizabeth, M. ,  SANDMAN, Timothy, B. ,  HUTTI, Jacob, M. ,  LORD, Jonathan, T. ,  WHITWORTH, Julie, E. ,  SHAW, Elizabeth, M. ,  FLEMING, William, K. ,  WATSON, HEIDARI, Teresa, L.

IPC: G06F17/60

CPC classification number: G06Q10/06 ,  G06Q40/02

Abstract: A pharmacy benefits plan is designed such that covered that covered scripts are placed into Groups and allowances are provided for the purchase of scripts within each Group. Each Group comprises scripts for pharmaceuticals that provided medical benefits within a given time frame. A first Major Group is assigned to scripts for drugs that are prescribed for conditions that would otherwise result in further medical treatment and expense if said drugs were not taken by an insured. A second Major Group is assigned to scripts for drugs that are prescribed for conditions that would not normally result in subsequent medical costs if the drugs were not taken. Relatively high allowances are provided for scripts in said first Major Group such that the out-of-pocket costs of a given scrip will not be a barrier to said insured obtaining and taking said scripts. Relatively low allowances are provided for scripts in said second Major Group such that an insured will be further motivated to ask their doctor about low cost alternative drugs for a given treatment.

Abstract translation: 设计了一个药店福利计划，以便涵盖所涵盖的脚本被放置在组中，并为每个组中的脚本购买提供了许可。 每个组包括在给定时间范围内提供医疗益处的药物的脚本。 第一个主要集团被指定为为另外导致进一步治疗和费用的药物规定的药物的脚本，如果所述药物未被被保险人采取。 第二个主要集团被指定为药物的脚本，这些药物的规定条件通常不会导致随后的医疗费用，如果不服用药物。 为第一主要群组的脚本提供相对较高的津贴，使得给定小费的自付费用不会成为所有被保险人获取和使用所述脚本的障碍。 为第二主要小组的脚本提供相对较低的津贴，使被保险人有进一步的动机，要求他们的医生关于给定治疗的低成本替代药物。

公开(公告)号：WO2005109279A3

公开(公告)日：2007-05-18

申请号：PCT/US2005014723

申请日：2005-05-02

Applicant: HUMANA INC ,  WARREN ELIZABETH M ,  SANDMAN TIMOTHY B ,  HUTTI JACOB M ,  LORD JONATHAN T ,  WHITWORTH JULIE E ,  SHAW ELIZABETH M ,  FLEMING WILLIAM K ,  WATSON HEIDARI TERESA L

Inventor： WARREN ELIZABETH M ,  SANDMAN TIMOTHY B ,  HUTTI JACOB M ,  LORD JONATHAN T ,  WHITWORTH JULIE E ,  SHAW ELIZABETH M ,  FLEMING WILLIAM K ,  WATSON HEIDARI TERESA L

IPC: G06Q10/00 ,  G06Q40/00

CPC classification number: G06Q10/06 ,  G06Q40/02

Abstract: A pharmacy benefits plan is designed such that covered that covered scripts are placed into Groups and allowances are provided for the purchase of scripts within each Group. Each Group comprises scripts for pharmaceuticals that provided medical benefits within a given time frame. A first Major Group is assigned to scripts for drugs that are prescribed for conditions that would otherwise result in further medical treatment and expense if said drugs were not taken by an insured. A second Major Group is assigned to scripts for drugs that are prescribed for conditions that would not normally result in subsequent medical costs if the drugs were not taken. Relatively high allowances are provided for scripts in said first Major Group such that the out-of-pocket costs of a given scrip will not be a barrier to said insured obtaining and taking said scripts. Relatively low allowances are provided for scripts in said second Major Group such that an insured will be further motivated to ask their doctor about low cost alternative drugs for a given treatment.

Abstract translation: 设计了一个药店福利计划，以便涵盖所涵盖的脚本被放置在组中，并为每个组中的脚本购买提供了许可。 每个组包括在给定时间范围内提供医疗益处的药物的脚本。 第一个主要集团被指定为为另外导致进一步治疗和费用的药物规定的药物的脚本，如果所述药物未被被保险人采取。 第二个主要集团被指定为药物的脚本，这些药物的规定条件通常不会导致随后的医疗费用，如果不服用药物。 为第一主要群组的脚本提供相对较高的津贴，使得给定小费的自付费用不会成为所有被保险人获取和使用所述脚本的障碍。 为第二主要小组的脚本提供相对较低的津贴，使被保险人有进一步的动机，要求他们的医生关于给定治疗的低成本替代药物。