In the conventional payment assessment strategy, a health care institution problems a prescription and prescribes and pays for the drug to the patient at an insurance policies pharmacy, and so forth., then the examination ask for for the professional medical follow is produced on the examination payment institution. However, it can be not possible to evaluate the suitability of the applying contents in advance for clinical institutions. Moreover, the insured / insurer (health insurance policies Affiliation, etc.) that bears the cost of prescribed drugs will not be totally informed about information on drugs for example efficacy and cost, and is totally informed about the existence of several alternate options. It is frequently not accomplished. This is why, the choice of medicines is totally left towards the judgment of a healthcare establishment, and it is actually tricky to work out the appropriate to pick medicines as a cost bearer and a consumer.
The existing creation pertains to transactions relevant to prescription and buy of ethical drugs in between suppliers and prescribers like healthcare establishments and insurance plan pharmacies and people for example examination payers, insurers and insured persons within the pharmaceutical distribution market. It results in being probable to make clear if There may be agreement concerning the parties in real time. As a result, the assessment / payment institution / insurance company will have a possibility to successfully Convey their intentions regarding the variety of drugs, which enables them to increase their selections for drug prescriptions they desire and increase their gratification and cost efficiency.
【解決手段】保険医療機関が処方する医薬品について、代替品情報、保険者の処方希望優先順位情報を入力・保持する手段、審査支払機関によるレセプト審査承認のための条件・基準を入力・保持する手段、医療機関から診療行為毎に、処方医薬品の保険適用可否に関する照会を受付け、被保険者の症状等の個人情報に基づき、照会内容が保険者・審査支払機関の指定条件に合致しているか否かを判定する手段、上記照会内容が指定条件に合致していない場合は、保険者が指定する医薬品の中から、症状等の被保険者の情報に基づき指定条件を満たす他の医薬品を検索し代替品として医療機関に通知、医療機関にて処方内容の再選択を促す手段を有するシステム。
At present, an information process that replaces the creation and application of the above-stated receipt with an electronic technique from a standard penned strategy has already been put into functional use. On the other hand, in the United States, Pharmacy Reward Administration (“PBM”) is a company that manages dispensing expenditures for policyholders.
従って、本発明の課題は、わが国の医療保険制度の中で、医療サービス受給の公平性を維持しつつ、被保険者・保険者もしくは審査支払機関が、代替品の中から最も強く処方を希望する医薬品を、医療機関・保険薬局が、他の代替品の中から優先的に採用する機会を提供することを可能にさせる、医療用医薬品処方情報照会・配信システムを提供することにある。
The prescription information inquiry / distribution program according to declare one, accepting inquiries from insurance policy pharmacies for coverage coverage of prescribed drugs explained in prescriptions issued by healthcare institutions, and existence of inquiry record with check here prescription issuing healthcare institutions Pharmaceutical prescription information inquiry and distribution procedure characterized by distributing success.
shopper and the moment it truly is signed from the doctor it brings about currently being a lawful doc! Prescriptions are essential for all
At this time, There exists an example that aims to Increase the perform performance by digitizing the health-related rate evaluation ask for rather than producing, but This really is targeted at labor preserving of Workplace get the job done at the clinical establishment.
) presented through the health-related institution at the time of inquiry and information obtained beforehand As well as in real-time if the desired situations of the insurance provider to whom the insured is affiliated plus the examination and payment organization in cost are happy.
How over and over have you still left the medical doctor’s office, only to search out you forgot to mention a significant piece of information?
図１は、本発明の医薬品処方情報照会・配信方法を活用したビジネスモデルの一例の概略を示す図面であり、図２は、当該ビジネスモデルをより具体的に示す図面であり、図３は、情報システム構成の一例を示す図面であり、図４は、情報照会・判定の一例を示すフローチャートであり、図５は、本発明の医薬品処方情報照会・配信のための情報システム内のデータファイルの一例を示す図面であり、図６は、当該情報システムと接続した医療機関の端末の入出力イメージの一例を示す図である。
Initial, in FIG. 1, the parties linked to the information procedure of your current invention will likely be clarified. This information method features a professional medical establishment that prescribes pharmaceuticals to the insured, an insurance pharmacy that dispenses prescription drugs dependant on a prescription issued because of the health care institution and presents them to your insured, an insurer that bears professional medical insurance policies expenses, and An evaluation / payment institution that examines health care fee facts from healthcare establishments / insurance pharmacies is connected. Just about every celebration supplies the information system using a series of important information to be described later.Inside the information process, (one) information on possibilities and prescriptions from the insurer for drugs prescribed through the insurance plan professional medical institution for the insured Enter / keep wished-for precedence information, (two) Enter / maintain circumstances / specifications for approval of receipt review by review / payment Corporation, (three) Inquire about availability of insurance plan for prescription drugs from clinical institutions for every clinical follow Depending on individual information such as acceptance, insured's symptom, clinical historical past, age, etc.
provide the most likely of remaining abused, and that can lead to properly being threats from Damaging effects if taken improperly,
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