Once the inquiry within the health care establishment, the final prescription articles is transmitted within the health-related establishment into the information method once the prescription drug is decided. When an insurance plan pharmacy inquires about The provision of insurance for pharmaceuticals described in prescriptions, the presence / absence in the inquiry heritage While using the medical establishment and the outcomes are distributed. Ultimately, a series of inquiry histories is dispersed into the assessment and payment establishment along with the insurance company, along with the information inquiry / judgment treatment is concluded.
The present invention for resolving the above-pointed out problems is made up of the subsequent elements. (1) Enter and hold information on substitutes and prescription priority information of insurers for prescription drugs prescribed by insurance policy health-related institutions for insured individuals (2) Enter and retain the ailments and criteria for receipt critique approval because of the evaluation and payment Business (3) Accepting inquiries from medical establishments with regards to the availability of insurance plan for prescription drugs for every health care practice, and producing inquiries according to personalized information like the insured's indicators, medical background, age, etcetera., and information on (1) and (2) higher than Judgment is built in serious time to ascertain if the information fulfills the circumstances specified by the insurance provider / evaluation and payment institution (4) If the above mentioned inquiries do not fulfill the specified disorders, seek out other drugs that satisfy the required situations determined by the insured's information for instance signs and symptoms, etcetera. Notify healthcare establishments and stimulate them to reselect prescription content.
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It is actually made up of assumed medical fee factors calculated for every harm and symptom labeled In keeping with scenario, drug rate regular of employed drugs, insurance coverage details, other details required for examination of healthcare price facts, etcetera. Pharmaceutical prescription information inquiry and distribution method.
以下に、図４を用いて情報照会・判定の手順の一例のフローチャートを説明する。まず審査支払機関・保険者・保険医療機関・保険薬局から必要な情報を取得する。審査支払機関及び保険者から取得する情報・指定条件は前述の通りであり、医療機関・保険薬局からは所在地等の基本情報に加え、使用希望薬剤情報・医薬品取扱情報・同在庫情報等を取得し、取得したデータを格納する。
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請求項１に記載の医薬品処方情報照会・配信システムにおいて、本システムを介して為された一連の照会履歴を審査支払機関及び保険者に配信することを特徴とする医薬品処方情報照会・配信システム。
The prescription information inquiry / distribution technique In keeping with claim 1, accepting inquiries from insurance plan pharmacies for insurance coverage of prescribed drugs explained in prescriptions issued by healthcare institutions, and presence of inquiry historical past with prescription issuing health care institutions Pharmaceutical prescription information inquiry and distribution program characterized by distributing success.
また、医薬品費用を負担する被保険者・保険者（健康保険組合等）が、効能・価格等の医薬品に関する情報を十分に知らされていない、複数の代替品の存在に関する情報を十分には知らされていない、といった場合が多い。このため、医薬品の選択に際しては医療機関の判断に全面的に委ねており、費用負担者及び需要者としての医薬品選択の権利が行使しにくい状況が生まれている。
At present, an information program that replaces the development and application of the above-described receipt by having an Digital system from a traditional penned process has now been set into simple use. Conversely, in America, Pharmacy Profit Administration (“PBM”) is a company that manages dispensing charges for policyholders.
An illustration of the configuration of these kinds of an information technique is shown in FIG. In this example of information process, no less than Screen and output device / input unit / information storage for instance common laptop computer with conversation signifies installed in each of assessment paying institution, insurance company, insurance plan clinical institution, insurance policies pharmacy In addition to a central program that performs information inquiry / dedication are related via a communication line including the online market place.
The professional medical prescription information inquiry / distribution program In line with claim 1, whereby the health care prescription is obtained from the medical establishment for each professional medical follow, and insured information (health-related insurance policies linked information, harm and sickness) introduced from the health-related establishment at the time of inquiry.
Following, the movement during which the means in the existing creation is executed will likely be explained in time sequence with reference to FIG.
Inside the planning stage with the process, the examination payer and the insurance provider enter needed information and specify situations. Examples of information entered from the evaluation payer here as well as insurer and the specified conditions are based upon information over the insurer issue to examination, circumstances like the insured's age, gender, Structure and past historical past There are assumed medical price factors calculated for each unique sickness and symptom divided, drug price expectations of applied drugs, coverage factors, along with other data necessary for examination of professional medical charge aspects.