The present invention pertains to transactions associated with prescription and purchase of moral drugs concerning suppliers and prescribers including medical institutions and insurance plan pharmacies and shoppers for instance evaluation payers, insurers and insured people during the pharmaceutical distribution market. It turns into doable to explain whether There is certainly agreement in between the parties in genuine time. Therefore, the examination / payment institution / insurer should have a chance to efficiently express their intentions concerning the variety of drugs, which will allow them to extend their choices for drug prescriptions they desire and make improvements to their pleasure and cost performance.
Become. Due to this fact, as an example, the assessment / payment agency raises the prescription precedence order of simpler medicines so a large number of clinical institutions can prescribe the medicines. Therefore, the standard of medical products and services plus the fairness of fees among insured people Promoted. Furthermore, an increase in prescription of the cheapest drug among the a plurality of drugs having the identical result may also be attained, including reduction in drug prices for insurers and insured individuals.
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An example of the configuration of these types of an information system is proven in FIG. In this instance of information method, no less than Exhibit and output unit / input unit / knowledge storage for instance ordinary laptop computer with communication indicates put in in each of examination paying out establishment, insurer, insurance clinical establishment, insurance policy pharmacy In addition to a central technique that performs information inquiry / determination are connected by using a conversation line including the online market place.
【選択図】図３[Challenges] To deliver a method for giving a possibility for just a healthcare establishment / insurance coverage pharmacy to preferentially undertake a medication that an insured / insurance company or examination / payment establishment really wants to prescribe within the healthcare insurance coverage program. Offered. [Indicates FOR SOLVING Complications] Entering / holding information on choices, prescription precedence order information of an insurance provider, and situations / expectations for approval of a receipt assessment by an evaluation / payment establishment for any medicine prescribed by an insurance coverage clinical institution Inquiries with regards to whether or not coverage for prescription drugs is readily available for each professional medical apply with the means and health-related establishment, and whether or not the inquiries match the desired problems from the insurance provider / assessment and payment Corporation based on particular information including signs or symptoms from the insured Implies to ascertain if the above inquiry written content won't match the required circumstances, seek out other drugs that fulfill the specified situations from the drugs specified through the insurance company based upon the insured's information such as signs and symptoms A program getting usually get more info means for notifying a health care establishment as an alternative and prompting the healthcare establishment to reselect prescription contents. [Selection] Figure 3 Description
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医療機関からの照会後、処方医薬品を確定した段階で医療機関から最終の処方内容が情報システムに送信される。保険薬局から処方箋記載の医薬品の保険適用の可否について照会があった場合には、医療機関との照会履歴の有無、結果を配信する。
医療機関による医薬品の処方に際しては、被保険者（患者）が保健医療機関で医師の診察を受け、その診断結果をもとに医師が処方箋を発行、同処方箋に基づき保険薬局にて医薬品が調剤、提供される、という流れになっている。保険が適用される医薬品の費用請求については、被保険者による一部費用負担を除くと、医療機関・保険薬局などが、レセプトと呼ばれる診療報酬明細書に、診療、検査、投薬、手術など医療行為の内容を記入し、月ごとに審査支払機関に提出、医療費を請求する。審査は、社会保険診療報酬支払基金と都道府県支部、国民健康保険中央会と各都道府県の国民健康保険団体連合会にて実施され、かかった医療費をそのまま医療保険から支払う「出来高払い制」を採用されている。
Now, There's an example that aims to Enhance the work efficiency by digitizing the health care charge evaluation request as an alternative to writing, but This is certainly directed at labor conserving of Business office operate within the professional medical establishment.
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Simultaneously, for prescription drugs that satisfy the specified problems, access the insurance policies pharmacy databases and check the handling and inventory information with the prescription drugs at a number of coverage pharmacies close to the tackle with the healthcare institution or the insured. . Furthermore, when an insurance policies pharmacy tends to make an inquiry in regards to the insurance plan software of the drugs explained in the prescription issued by a clinical institution, the presence or absence of the inquiry heritage Along with the prescription issuing clinical institution and The end result are distributed.
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