Healthcare needs fulfillment system

Abstract

Systems for filling and managing a patient's healthcare needs are provided. Some systems and methods described herein relate to a total healthcare fulfillment system. The healthcare fulfillment system of various embodiments is a central portal which coordinates with physicians, retail pharmacies, mail-order pharmacies, specialty providers, and patients in order to address all of a patient's prescription drug needs or other healthcare needs.

What is claimed is: 
     
         1 . A method of fulfilling and managing prescribed healthcare goods and services, the method comprising:
 receiving a prescription electronically, wherein the prescription comprises a prescribed healthcare good or service;   receiving patient information electronically, wherein the patient information comprises an identifier linking a patient to a prescription benefit plan;   accessing a database of pricing data comprising current prices of goods and services at a plurality of participating pharmacies;   determining a suggested pharmacy based at least in part on the prescribed healthcare good or service, the prescription benefit plan, and the current pricing data; and   sending the prescription electronically to a selected pharmacy for fulfillment.   
     
     
         2 . The method of  claim 1 , wherein the suggested pharmacy is also determined based at least in part on the location of the plurality of participating pharmacies. 
     
     
         3 . The method of  claim 1 , wherein the suggested pharmacy is automatically chosen to be the selected pharmacy. 
     
     
         4 . The method of  claim 1 , wherein identifying a suggested pharmacy comprises:
 identifying a plurality of suggested pharmacy options,   providing a list of the suggested pharmacy options to a user in a selectable format, and   receiving an input from the user indicating the selected pharmacy.   
     
     
         5 . The method of  claim 4 , wherein the plurality of suggested pharmacy options comprises a mail-order option and one or more retail pharmacies. 
     
     
         6 . The method of  claim 4 , wherein the user is the patient or healthcare provider of the patient. 
     
     
         7 . The method of  claim 1 , wherein the identifier is a patient-specific identification code or username linking the patient to a patient-specific profile, which stores patient-specific information, including at least the patient's: prescription benefit plan, birthdate, name, address, and current prescriptions. 
     
     
         8 . The method of  claim 7 , wherein the patient-specific profile also stores financial account information for the patient, and wherein the method further comprises deducting payment from the financial account information when the prescription is received, adjudicated, or fulfilled by the selected pharmacy. 
     
     
         9 . The method of  claim 1 , further comprising:
 tracking the prescription electronically; and   updating a prescription status that is viewable by a user when the selected pharmacy receives the prescription, when the selected pharmacy adjudicates the prescription, and when the selected pharmacy fulfills the prescription.   
     
     
         10 . The method of  claim 1 , further comprising:
 receiving a question from the patient;   identifying a category to which the question pertains; and   directing the question to an appropriate resource, wherein:
 an order status question or a payment question is directed to the selected pharmacy, 
 a benefits question is directed to the patient's pharmacy benefits manager, and 
 a health question is directed to a professional health services representative or healthcare provider. 
   
     
     
         11 . The method of  claim 1 , wherein the current prices of goods and services are updated periodically to reflect pricing data received from a plurality of participating pharmacies during a bidding process, wherein the bidding process comprises:
 providing various pharmacies with access to participate in bidding covering a next pricing cycle; and   receiving bids for the next pricing cycle from a plurality of participating pharmacies.   
     
     
         12 . A system for fulfilling and managing prescriptions, the system comprising:
 a receiver configured to receive an electronic prescription and patient information, wherein the electronic prescription comprises a prescribed good or service, and the patient information comprises an identifier linking a patient to a prescription benefit plan;   a database of pricing data comprising current prices of healthcare goods and services at a plurality of participating pharmacies;   a processor configured to determine a suggested pharmacy based at least in part on the prescribed good or service, the prescription benefit plan, and the current pricing data; and   a transmitter configured to send the electronic prescription via a web-based interface to a selected pharmacy for fulfillment.   
     
     
         13 . The system of  claim 12 , further comprising a memory configured to store a patient-specific profile, which comprises patient-specific information, including at least the patient's: prescription benefit plan, birthdate, name, address, and current prescriptions. 
     
     
         14 . The system of  claim 12 , further comprising a memory configured to store pharmacy-specific information, including at least a name and an address for each pharmacy. 
     
     
         15 . The system of  claim 13 , wherein the memory comprises a web-accessible database. 
     
     
         16 . A method of fulfilling and managing prescriptions, the method comprising:
 receiving a processed claim record from a payor, PBM, or claim aggregator, wherein the processed claim record identifies a fulfilling pharmacy, a prescribed good or service, a patient, and an address of the patient;   generating an eligible claim switch file;   sending the eligible claim switch file to a pharmacy evaluator;   receiving a report from the pharmacy evaluator identifying a suggested pharmacy, wherein the pharmacy evaluator identifies a suggested pharmacy by evaluating a plurality of pharmacies at least in part on proximity to the patient and price of the prescribed good or service;   determining if the patient is a target patient, wherein a patient is a target patient if the fulfilling pharmacy is not the suggested pharmacy; and   sending a list including the target patient to a caller for contacting to determine if the target patient wants to transfer the prescription to the suggested pharmacy.   
     
     
         17 . The method of  claim 16 , wherein the suggested pharmacy comprises a plurality of suggested pharmacy options. 
     
     
         18 . The method of  claim 16 , further comprising:
 calling the target patient to determine if the target patient would like to transfer the prescription to the suggested pharmacy.   
     
     
         19 . The method of  claim 16 , further comprising:
 receiving a notification from the caller when the target patient authorizes a transfer to a new pharmacy; and   contacting the new pharmacy to transfer the prescription for the patient, wherein the new pharmacy is the suggested pharmacy or one of the plurality of suggested pharmacy options.   
     
     
         20 . The method of  claim 16 , wherein the pharmacy evaluator is an outside vendor or operated by an outside vendor. 
     
     
         21 . The method of  claim 16 , wherein the pharmacy evaluator is a server or computer. 
     
     
         22 . The method of  claim 16 , wherein the caller is an outside vendor or operated by an outside vendor. 
     
     
         23 . The method of  claim 16 , wherein the caller is a person or computer. 
     
     
         24 . A system for fulfilling and managing prescriptions, the system comprising:
 a receiver configured to receive a processed claim record from a payor, PBM, or claim aggregator via a web-based interface, wherein the processed claim record identifies a fulfilling pharmacy, a prescribed good or service, a patient, and an address of the patient;   a processor configured to generate an eligible claim switch file; and   a transmitter configured to send the eligible claim switch file to a pharmacy evaluator; wherein:   the receiver is further configured to receive a report from the pharmacy evaluator identifying a suggested pharmacy,   the processor is further configured to determine if the patient is a target patient, wherein a patient is a target patient if the fulfilling pharmacy is not the suggested pharmacy, and   the transmitter is further configured to send a list including the target patient to a caller for contacting to determine if the target patient wants to transfer the prescription to the suggested pharmacy.