Methods and systems for implementation of therapy programs

Abstract

Methods and systems for implementation of therapy programs are described. In one embodiment, it is determined that a member is enrolled in a drug benefit program. It is determined that a decision deadline has occurred for continuing an aspect of a benefit of the drug benefit program. It is determined that a decision response has not been received from the member. A suspension of the aspect of the benefit of the drug benefit program is generated based on the determination that the decision response has not been received from the member. Other methods and systems are described.

1 . A method comprising:
 determining, on a processor, that a member is enrolled in a drug benefit program;   determining, on the processor, that a decision deadline has occurred for continuing an aspect of a benefit of the drug benefit program;   determining, on the processor, that a decision response has not been received from the member; and   generating, on the processor, a suspension of the aspect of the benefit of the drug benefit program based on the determination that the decision response has not been received from the member.   
     
     
         2 . The method according to  claim 1 , further comprising:
 generating a notification that a decision response is required prior to the decision deadline; and   transmitting the notification to the member.   
     
     
         3 . The method according to  claim 2 , further comprising:
 determining that the decision deadline is applicable to the member; and   wherein generation the notification is in response to the determination that the decision deadline id applicable to the member.   
     
     
         4 . The method according to  claim 3 , wherein determining that the decision deadline is applicable to the member comprises:
 accessing member data associated with the member; and   comparing the member data associated with the member to therapy implementation program criterion associated with the decision deadline.   
     
     
         5 . The method according to  claim 1 , further comprising:
 implementing an intervention based on the generation of the suspension of the aspect of the benefit of the drug benefit program.   
     
     
         6 . The method according to  claim 5 , wherein the aspect of the benefit includes a prescription drug selection benefit available to the member. 
     
     
         7 . The method according to  claim 5 , wherein the aspect of the benefit includes a pharmacy network selection benefit available to the member. 
     
     
         8 . The method according to  claim 5 , wherein the aspect of the benefit includes a prescription drug delivery channel benefit available to the member. 
     
     
         9 . A method comprising:
 determining, on a processor, that a member of a drug benefit program qualifies for a therapy implementation program associated with the drug benefit program;   generating, on the processor, a notification for the member based on the determination that the member qualifies for the therapy implementation program;   determining, on the processor, that a member response has not been received; and   altering, on the processor, an aspect of a benefit of the drug benefit program based on the determination that the member response has not been received.   
     
     
         10 . The method of  claim 9 , wherein the aspect of the benefit of the drug benefit program includes a prescription drug selection available to the member. 
     
     
         11 . The method of  claim 9 , wherein the aspect of the benefit of the drug benefit program includes a pharmacy network selection available to the member. 
     
     
         12 . The method of  claim 9 , wherein the aspect of the benefit of the drug benefit program includes a prescription drug access channel available to the member. 
     
     
         13 . The method of  claim 9 , further comprising:
 receiving a prescription refill request by the member; and   implementing a pharmacy intervention based on the alteration of the aspect of the benefit of the drug benefit program and based on receipt of the prescription refill request by the member.   
     
     
         14 . The method of  claim 9 , further comprising:
 generating an early phase communication regarding the therapy implementation program.   
     
     
         15 . A method comprising:
 determining, on a processor, that a member of a drug benefit program qualifies for a prescription drug home delivery program associated with the drug benefit program;   generating, on the processor, a notification for the member based on the determination that the member qualifies for the prescription drug home delivery program;   determining, on the processor, that a member response has not been received before the occurrence of a decision deadline; and   altering, on the processor, a retail pharmacy coverage aspect of the drug benefit program based on the determination that the member response has not been received.   
     
     
         16 . The method of  claim 15 , further comprising:
 receiving a prescription refill request by the member; and   implementing a pharmacy intervention based on the alteration of the retail pharmacy coverage aspect of the drug benefit program and based on receipt of the prescription refill request by the member.   
     
     
         17 . The method of  claim 15 , wherein the prescription drug home delivery program includes a specialty drug home delivery program. 
     
     
         18 . A method comprising:
 determining, on a processor, that a member of a drug benefit program qualifies for a value-enhanced pharmacy network program associated with the drug benefit program;   generating, on the processor, a notification for the member based on the determination that the member qualifies for the value-enhanced pharmacy network program associated with the drug benefit program;   determining, on the processor, that a member response has not been received before the occurrence of a decision deadline; and   altering, on the processor, a pharmacy network selection coverage of the drug benefit program based on the determination that the member response has not been received.   
     
     
         19 . The method of  claim 18 , wherein altering the pharmacy network selection coverage comprises:
 enrolling the member in the value-enhanced pharmacy network program.   
     
     
         20 . The method of  claim 19 , further comprising:
 receiving a prescription refill request by the member for a pharmacy not within the value-enhanced pharmacy network program; and   implementing a pharmacy intervention based on the enrollment of the member in the value-enhanced pharmacy network program.   
     
     
         21 . A method comprising:
 determining, on a processor, that a member of a drug benefit program qualifies for a prescription drug selection program associated with the drug benefit program;   generating, on the processor, a notification for the member based on the determination that the member qualifies for the prescription drug selection program;   determining, on the processor, that a member response has not been received before the occurrence of a decision deadline; and   altering, on the processor, a prescription drug selection aspect of the drug benefit program based on the determination that the member response has not been received.   
     
     
         22 . The method of  claim 21 , wherein altering the prescription drug selection aspect of the drug benefit program comprises:
 suspending coverage for non-formulary prescription drugs.   
     
     
         23 . The method of  claim 21 , further comprising:
 receiving a prescription refill request by the member; and   implementing a pharmacy intervention based on the alteration of the prescription drug selection aspect of the drug benefit program and based on receipt of the prescription refill request by the member.   
     
     
         24 . A non-transitory machine-readable medium comprising instructions, which when executed by one or more processors, cause the one or more processors to perform the following operations:
 determine that a member is enrolled in a drug benefit program;   determine that a decision deadline has occurred for continuing an aspect of a benefit of the drug benefit program;   determine that a decision response has not been received from the member; and   generate a suspension of the aspect of the benefit of the drug benefit program based on the determination that the decision response has not been received from the member.