Systems and methods for administration of prescription drug benefits

Abstract

The invention relates to the administration of prescription drug formulary information. A list of drugs that a particular prescription drug plan will pay for in whole or in part is called a formulary. The invention involves the use of information and customizable rules associated with formularies, combined with information from patient medical records, to generate custom, dynamic formularies applicable to specific patients, groups of patients, or both. Depending on the choice of rules and the other information, this may help payers control prescription drug costs by encouraging the use of less-expensive drugs when medically appropriate, but without impairing the freedom of prescribers to prescribe specific drugs according to their professional judgments. Some embodiments may also be adapted to generate and store data about the use and functioning of the embodiments or aspects of them and to generate reports containing some or all such data in response to queries.

1 . A computerized information management system for providing prescription drug related data for a specific patient or a group of patients, the system comprising:
 at least one interface for receiving data associated with patient medical records;   at least one interface for receiving data associated with a first set of formulary data; and   software programming adapted to receive at least one rule and provide a second set of formulary data based on applying the received rule to both the data associated with the patient medical records received at the first interface and the data associated with the first set of formulary data received at the second interface.