INTEGRATED PHARMACEUTICAL BENEFITS MANAGEMENT SYSTEMS

Abstract

ABSTRACT Integrated Pharmaceutical Benefits Management Systems The present disclosure introduces an integrated pharmaceutical benefits management system 100 which optimizes prescription drug administration using a centralized cloud-based platform 102 for real-time data synchronization. It comprises a data integration module 104 to ensure interoperability with healthcare IT systems and predictive analytics engine 106 to analyze patterns and provide proactive interventions. The system features drug cost transparency and comparison module 108 to offer real-time pricing options and a specialty drug management system 110 to handle logistics for complex medications. A blockchain ledger for data security and audit trail 122 ensures integrity, while a pharmacogenomics-based dosing module 124 enables personalized therapy based on genetic data. Other components are automated prior authorization and eligibility verification system 118, an AI-driven drug interaction and polypharmacy monitoring tool 138, a dynamic copayment optimization engine 132, and a patient-centric mobile application 116 for enhanced user engagement.

Specification

Description:INTEGRATED PHARMACEUTICAL BENEFITS MANAGEMENT SYSTEMS
TECHNICAL FIELD
[0001] The present innovation relates to healthcare technology, specifically to systems and methods for managing pharmaceutical benefits through integrated platforms.

BACKGROUND

[0002] The management of pharmaceutical benefits has long been a challenge in the healthcare industry due to the fragmented and inefficient nature of traditional systems. Existing Pharmaceutical Benefits Management (PBM) systems serve as intermediaries between healthcare payers, pharmacies, and pharmaceutical manufacturers. While these systems handle tasks such as claim processing, price negotiations, and formulary management, they often operate in silos, resulting in fragmented data flow, lack of transparency, and inefficiencies. Patients, healthcare providers, and payers face significant hurdles, such as delays in accessing medications, high out-of-pocket costs, and poor medication adherence. Specialty drug management further complicates the process due to high costs, complex administration, and specific storage requirements.

[0003] Available options include traditional PBM models, manual claims processing, and isolated healthcare IT systems like Electronic Health Records (EHRs). However, these solutions have critical drawbacks: limited data integration across stakeholders, inadequate cost transparency, inability to monitor adherence effectively, and challenges in adapting to evolving regulations. These limitations often lead to suboptimal patient outcomes, increased administrative burden, and inefficiencies in cost and resource management.

[0004] The proposed Integrated Pharmaceutical Benefits Management (IPBM) system addresses these drawbacks through a unified platform that integrates all stakeholders in the pharmaceutical supply chain. By leveraging advanced data analytics, artificial intelligence, and real-time processing, the invention provides seamless data flow, dynamic cost transparency, and predictive adherence tools. The system offers unique features such as real-time prescription tracking, automated value-based contracting, specialty drug management, and patient-centric mobile applications.

[0005] The novelty lies in its ability to bridge gaps between stakeholders, provide actionable insights through AI, and offer real-time regulatory compliance. This invention not only optimizes pharmaceutical benefits administration but also enhances patient outcomes by improving access, adherence, and transparency, setting it apart from existing systems.

OBJECTS OF THE INVENTION
[0006] The primary object of the invention is to streamline pharmaceutical benefits management by integrating all stakeholders into a unified platform for real-time collaboration and data sharing.

[0007] Another object of the invention is to enhance medication adherence by utilizing predictive analytics and AI to identify at-risk patients and provide targeted interventions.

[0008] Another object of the invention is to improve cost transparency for patients and payers by offering real-time drug price comparisons and dynamic copayment optimization.

[0009] Another object of the invention is to provide effective management of specialty medications by enabling real-time tracking, adherence monitoring, and tailored patient support.

[00010] Another object of the invention is to ensure regulatory compliance through automated monitoring, real-time drug utilization review, and adherence to healthcare data security standards.

[00011] Another object of the invention is to reduce administrative burden by automating eligibility verification, prior authorization workflows, and claims processing.

[00012] Another object of the invention is to support value-based care models by linking drug performance to reimbursement structures and enabling dynamic outcome-based contracts.

[00013] Another object of the invention is to empower patients with a user-friendly mobile application for prescription tracking, medication reminders, and direct communication with healthcare providers.

[00014] Another object of the invention is to improve decision-making for all stakeholders by providing real-time insights through customizable analytics dashboards and AI-driven recommendations.

[00015] Another object of the invention is to advance the healthcare ecosystem by leveraging interoperability standards to integrate seamlessly with existing IT systems and support scalability across diverse healthcare settings.




SUMMARY OF THE INVENTION

[00016] In accordance with the different aspects of the present invention integrated pharmaceutical benefits management system is presented that streamlines the administration, delivery, and financial oversight of prescription drug benefits. It integrates stakeholders such as healthcare providers, pharmacies, insurers, manufacturers, and patients into a unified, real-time platform. Leveraging advanced data analytics, AI, and automation, the system enhances cost transparency, medication adherence, and specialty drug management. It supports regulatory compliance, value-based care models, and offers patient-centric tools like a mobile application for prescription management. This innovative approach improves efficiency, reduces costs, and promotes better healthcare outcomes.

[00017] Additional aspects, advantages, features and objects of the present disclosure would be made apparent from the drawings and the detailed description of the illustrative embodiments constructed in conjunction with the appended claims that follow.

[00018] It will be appreciated that features of the present disclosure are susceptible to being combined in various combinations without departing from the scope of the present disclosure as defined by the appended claims.

BRIEF DESCRIPTION OF DRAWINGS
[00019] The summary above, as well as the following detailed description of illustrative embodiments, is better understood when read in conjunction with the appended drawings. For the purpose of illustrating the present disclosure, exemplary constructions of the disclosure are shown in the drawings. However, the present disclosure is not limited to specific methods and instrumentalities disclosed herein. Moreover, those in the art will understand that the drawings are not to scale. Wherever possible, like elements have been indicated by identical numbers.

[00020] Embodiments of the present disclosure will now be described, by way of example only, with reference to the following diagrams wherein:

[00021] FIG. 1 is component wise drawing for integrated pharmaceutical benefits management system.

[00022] FIG 2 is working methodology of integrated pharmaceutical benefits management system.

DETAILED DESCRIPTION

[00023] The following detailed description illustrates embodiments of the present disclosure and ways in which they can be implemented. Although some modes of carrying out the present disclosure have been disclosed, those skilled in the art would recognise that other embodiments for carrying out or practising the present disclosure are also possible.

[00024] The description set forth below in connection with the appended drawings is intended as a description of certain embodiments of integrated pharmaceutical benefits management system and is not intended to represent the only forms that may be developed or utilised. The description sets forth the various structures and/or functions in connection with the illustrated embodiments; however, it is to be understood that the disclosed embodiments are merely exemplary of the disclosure that may be embodied in various and alternative forms. The figures are not necessarily to scale; some features may be exaggerated or minimised to show details of particular components. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a representative basis for teaching one skilled in the art to variously employ the present invention.

[00025] While the disclosure is susceptible to various modifications and alternative forms, specific embodiment thereof has been shown by way of example in the drawings and will be described in detail below. It should be understood, however, that it is not intended to limit the disclosure to the particular forms disclosed, but on the contrary, the disclosure is to cover all modifications, equivalents, and alternatives falling within the scope of the disclosure.

[00026] The terms "comprises", "comprising", "include(s)", or any other variations thereof, are intended to cover a non-exclusive inclusion, such that a setup, or system that comprises a list of components or steps does not include only those components or steps but may include other components or steps not expressly listed or inherent to such setup or system. In other words, one or more elements in a system or apparatus preceded by "comprises... a" does not, without more constraints, preclude the existence of other elements or additional elements in the system or apparatus.

[00027] In the following detailed description of the embodiments of the disclosure, reference is made to the accompanying drawings and which are shown by way of illustration-specific embodiments in which the disclosure may be practiced. These embodiments are described in sufficient detail to enable those skilled in the art to practice the disclosure, and it is to be understood that other embodiments may be utilized and that changes may be made without departing from the scope of the present disclosure. The following description is, therefore, not to be taken in a limiting sense.

[00028] The present disclosure will be described herein below with reference to the accompanying drawings. In the following description, well-known functions or constructions are not described in detail since they would obscure the description with unnecessary detail.

[00029] Referring to Fig. 1, integrated pharmaceutical benefits management system 100 is disclosed in accordance with one embodiment of the present invention. It comprises of centralized cloud-based platform 102, data integration module 104, predictive analytics engine 106, drug cost transparency and comparison module 108, specialty drug management system 110, value-based contracting system 112, regulatory compliance module 114, patient-centric mobile application 116, automated prior authorization and eligibility verification system 118, real-time reporting and analytics dashboard 120, block chain ledger for data security and audit trail 122, pharmacogenomics-based dosing module 124, telepharmacy and virtual consultation platform 126, wearable device integration 128, fraud detection and prevention system 130, dynamic co-payment optimization engine 132, automated therapeutic substitution module 134, drug utilization review (DUR) system 136, AI-driven drug interaction and polypharmacy monitoring tool 138, crowd sourced drug pricing feedback system 140, medication discontinuation risk prediction engine 142.

[00030] Referring to Fig. 1, the present disclosure provides details of integrated pharmaceutical benefits management system 100. It is designed to optimize the administration, delivery, and financial oversight of prescription drug benefits. It seamlessly integrates stakeholders such as healthcare providers, pharmacies, payers, manufacturers, and patients through a centralized cloud-based platform 102, enabling real-time data synchronization and transparency. Key components include a predictive analytics engine 106 for medication adherence, a drug cost transparency and comparison module 108, and a specialty drug management system 110 for handling high-cost medications. The system also features a value-based contracting system 112, a regulatory compliance module 114, and a patient-centric mobile application 116 for enhanced user engagement. Additional functionality is provided by components such as the drug utilization review system 136 and the ai-driven drug interaction and polypharmacy monitoring tool 138, ensuring safety and efficacy. These components collectively address inefficiencies in traditional PBM systems while enhancing cost-efficiency, regulatory compliance, and patient outcomes.

[00031] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with centralized cloud-based platform 102, which acts as the foundation for real-time data sharing and synchronization among stakeholders. It enables seamless connectivity between healthcare providers, pharmacies, payers, and patients, ensuring efficient communication. This platform integrates directly with data integration module 104 to maintain consistent information flow and supports predictive analytics engine 106 for advanced decision-making. The centralized cloud-based platform 102 ensures data security and scalability, making it adaptable for various healthcare environments.

[00032] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with data integration module 104, which facilitates interoperability with existing healthcare IT systems such as electronic health records and pharmacy information systems. It ensures smooth data exchange and eliminates redundancies by synchronizing with centralized cloud-based platform 102. The module interacts dynamically with regulatory compliance module 114 to ensure data adherence to healthcare standards. This integration streamlines workflows and enables predictive analytics engine 106 to process consolidated datasets.

[00033] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with predictive analytics engine 106, which uses machine learning algorithms to predict patient adherence and identify risk factors. This component analyzes historical data, patient behavior, and prescription patterns to provide actionable insights. It works closely with drug cost transparency and comparison module 108 to recommend cost-effective alternatives and with patient-centric mobile application 116 to send adherence notifications. The predictive analytics engine 106 plays a pivotal role in enhancing patient outcomes through early intervention strategies.

[00034] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with drug cost transparency and comparison module 108, which enables real-time visibility into drug pricing across pharmacies. It integrates insurance co-pays, discounts, and rebate programs to offer cost-effective options for patients. This module interacts with specialty drug management system 110 to provide transparent pricing for high-cost medications and communicates directly with patient-centric mobile application 116 for user access. The drug cost transparency and comparison module 108 empowers patients to make informed decisions about their prescriptions.

[00035] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with specialty drug management system 110, which handles high-cost, complex medications requiring specific storage and administration. It ensures compliance with logistical requirements and tracks medication adherence through wearable device integration 128. This system interacts with value-based contracting system 112 to link drug costs with outcomes and provides educational support via patient-centric mobile application 116. The specialty drug management system 110 optimizes the management and delivery of specialty therapies.

[00036] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with value-based contracting system 112, which automates the tracking and linking of drug performance with reimbursement structures. This component continuously monitors patient outcomes and interacts with regulatory compliance module 114 to ensure adherence to healthcare standards. It integrates seamlessly with real-time reporting and analytics dashboard 120 to provide insights for performance-based contracts. The value-based contracting system 112 supports payers and manufacturers in establishing transparent and outcome-driven agreements.

[00037] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with regulatory compliance module 114, which ensures the system adheres to healthcare standards such as HIPAA and formulary guidelines. This module automates compliance checks, working closely with automated prior authorization and eligibility verification system 118 to streamline approvals. It also interacts with drug utilization review system 136 to flag potential safety or compliance issues. The regulatory compliance module 114 minimizes risks while maintaining system efficiency.

[00038] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with patient-centric mobile application 116, which offers patients tools to manage prescriptions, receive medication reminders, and check drug costs. The application communicates with drug cost transparency and comparison module 108 to display pricing information and integrates with wearable device integration 128 for adherence tracking. By connecting patients with healthcare providers through real-time messaging, the patient-centric mobile application 116 improves patient engagement and outcomes.

[00039] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with automated prior authorization and eligibility verification system 118, which processes insurance coverage and formulary restrictions in real-time. It integrates with centralized cloud-based platform 102 to reduce administrative delays and provides instant feedback to healthcare providers via data integration module 104. This system streamlines the prescription process, ensuring faster access to necessary medications.

[00040] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with real-time reporting and analytics dashboard 120, which delivers insights on drug utilization, cost trends, and patient adherence. The dashboard communicates with predictive analytics engine 106 to display actionable recommendations and supports decision-making for stakeholders. By integrating with value-based contracting system 112, the real-time reporting and analytics dashboard 120 aids in evaluating outcome-driven metrics.

[00041] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with blockchain ledger for data security and audit trail 122, which ensures the immutability and transparency of prescription transactions, claims and patient data. This provides a secure, transparent audit trail that can be accessed by authorized stakeholders, ensuring data accuracy, reducing fraud, and ensuring regulatory compliance. It interacts with regulatory compliance module 114 to meet data security standards and integrates with fraud detection and prevention system 130 to identify anomalies. The blockchain ledger for data security and audit trail 122 guarantees the integrity of sensitive healthcare information.

[00042] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with pharmacogenomics-based dosing module 124, which tailors medication dosing based on a patient's genetic profile. It works closely with predictive analytics engine 106 to recommend personalized therapies and integrates with drug utilization review system 136 to ensure safety and efficacy. The pharmacogenomics-based dosing module 124 enhances precision medicine by optimizing treatment outcomes.

[00043] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with telepharmacy and virtual consultation platform 126, which facilitates real-time interaction between patients and pharmacists. It integrates with patient-centric mobile application 116 for appointment scheduling and educational support. By leveraging wearable device integration 128, the telepharmacy and virtual consultation platform 126 enhances patient care through remote counseling.

[00044] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with wearable device integration 128, which tracks patient adherence and sends medication reminders. It communicates with predictive analytics engine 106 to share real-time adherence data and integrates with patient-centric mobile application 116 for user notifications. The wearable device integration 128 ensures continuous monitoring for improved medication management.

[00045] Referring to Fig. 1, the integrated pharmaceutical benefits management system is provided with fraud detection and prevention system 130, which monitors prescription and claims data to identify anomalies. It uses machine learning algorithms to detect potential fraud and works closely with blockchain ledger for data security and audit trail 122 for transaction validation. The fraud detection and prevention system 130 enhances system reliability and reduces financial losses.

[00046] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with dynamic copayment optimization engine 132, which analyzes discount programs, patient income, and formulary alternatives to minimize out-of-pocket costs. It communicates with drug cost transparency and comparison module 108 to display real-time cost savings for patients. The dynamic copayment optimization engine 132 ensures affordability while maintaining therapy quality.

[00047] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with automated therapeutic substitution module 134, which suggests cost-effective or formulary-compliant alternatives to prescribed medications. It integrates with automated prior authorization and eligibility verification system 118 to verify substitution eligibility. The automated therapeutic substitution module 134 ensures cost-effective treatment without compromising patient care.

[00048] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with drug utilization review system 136, which ensures patient safety by monitoring prescriptions for interactions, duplications, or contraindications. It interacts with regulatory compliance module 114 to flag non-compliance and works with blockchain ledger for data security and audit trail 122 to document findings. The drug utilization review system 136 promotes safer prescribing practices.

[00049] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with AI-driven drug interaction and polypharmacy monitoring tool 138, which continuously evaluates prescriptions for potential interactions or polypharmacy risks. By analysing the patient's full medication history, including over-the-counter medications and supplements, the system 138 alerts prescribers and pharmacists of any potentially harmful interactions and recommends safer alternatives. It integrates with pharmacogenomics-based dosing module 124 for personalized recommendations and provides alerts through patient-centric mobile application 116. The AI-driven drug interaction and polypharmacy monitoring tool 138 enhances medication safety and efficacy.

[00050] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with crowd sourced drug pricing feedback system 140, which aggregates real-world drug price data reported by patients. It works with drug cost transparency and comparison module 108 to refine pricing recommendations and displays updated data through patient-centric mobile application 116. The crowd sourced drug pricing feedback system 140 enhances cost transparency with user-driven insights.

[00051] Referring to Fig. 1, the integrated pharmaceutical benefits management system 100 is provided with medication discontinuation risk prediction engine 142, which predicts the likelihood of therapy discontinuation based on patient behavior and socioeconomic factors. It integrates with predictive analytics engine 106 to trigger timely interventions and connects with telepharmacy and virtual consultation platform 126 for patient counseling. The medication discontinuation risk prediction engine 142 ensures continuous care and improved adherence.

[00052] Referring to Fig 2, there is illustrated method 200 for integrated pharmaceutical benefits management system 100. The method comprises:
At step 202, method 200 includes user inputting a prescription into the system via patient-centric mobile application 116 or through healthcare provider integration with data integration module 104;
At step 204, method 200 includes the system automatically verifying patient eligibility and insurance coverage using automated prior authorization and eligibility verification system 118;
At step 206, method 200 includes the verified prescription data being synchronized across stakeholders via centralized cloud-based platform 102 to ensure seamless communication;
At step 208, method 200 includes predictive analytics engine 106 analyzing patient adherence patterns and triggering reminders or interventions through patient-centric mobile application 116;
At step 210, method 200 includes drug cost transparency and comparison module 108 providing real-time pricing options, including co-pays and discounts, for the prescribed medication;
At step 212, method 200 includes specialty drug management system 110 monitoring logistics, storage, and adherence for high-cost specialty medications, if applicable;
At step 214, method 200 includes drug utilization review system 136 performing real-time safety checks for interactions or contraindications, with any alerts shared via patient-centric mobile application 116;
At step 216, method 200 includes dynamic copayment optimization engine 132 calculating and displaying optimized out-of-pocket costs for the medication based on discounts and patient income;
At step 218, method 200 includes blockchain ledger for data security and audit trail 122 securely recording all transactions and interactions to maintain data integrity;
At step 220, method 200 includes telepharmacy and virtual consultation platform 126 facilitating real-time counseling or support for patients, particularly for specialty medications;
At step 222, method 200 includes predictive analytics engine 106 collaborating with medication discontinuation risk prediction engine 142 to flag potential discontinuation risks and suggest interventions;
At step 224, method 200 includes the system generating comprehensive reports on adherence, cost trends, and outcomes using real-time reporting and analytics dashboard 120 for stakeholder review;
At step 226, method 200 includes fraud detection and prevention system 130 monitoring for anomalies in claims and prescription data to enhance security and minimize financial losses;
At step 228, method 200 includes ai-driven drug interaction and polypharmacy monitoring tool 138 analyzing patient prescriptions in real-time to detect and alert for potential safety risks;
At step 230, method 200 includes crowdsourced drug pricing feedback system 140 collecting real-world pricing data from patients and refining cost comparison insights;
At step 232, method 200 includes pharmacogenomics-based dosing module 124 using genetic data to recommend personalized medication dosages for optimized outcomes.
[00053] The invention offers numerous advantages by addressing the limitations of traditional pharmaceutical benefits management systems through its integrated and innovative approach. By leveraging the centralized cloud-based platform 102, the system ensures real-time synchronization of data among stakeholders, eliminating inefficiencies caused by fragmented workflows. The predictive analytics engine 106 enhances patient outcomes by proactively identifying medication adherence risks and enabling timely interventions. The drug cost transparency and comparison module 108 empowers patients with real-time visibility into pricing options, reducing financial barriers to medication access. The specialty drug management system 110 optimizes the handling and monitoring of high-cost, complex therapies, while the dynamic copayment optimization engine 132 ensures affordability for patients. Furthermore, the blockchain ledger for data security and audit trail 122 guarantees transparency and integrity of transactions, enhancing trust among stakeholders. The inclusion of pharmacogenomics-based dosing module 124 allows for personalized treatment plans, improving therapeutic efficacy and reducing adverse effects. Overall, the invention integrates advanced automation, AI, and real-time processing to create a seamless, cost-effective, and patient-centric pharmaceutical benefits management system, ultimately improving healthcare delivery and outcomes.

[00054] In the description of the present invention, it is also to be noted that, unless otherwise explicitly specified or limited, the terms "fixed" "attached" "disposed," "mounted," and "connected" are to be construed broadly, and may for example be fixedly connected, detachably connected, or integrally connected, either mechanically or electrically. They may be connected directly or indirectly through intervening media, or they may be interconnected between two elements. The specific meaning of the above terms in the present invention can be understood in specific cases to those skilled in the art.

[00055] Modifications to embodiments of the present disclosure described in the foregoing are possible without departing from the scope of the present disclosure as defined by the accompanying claims. Expressions such as "including", "comprising", "incorporating", "have", "is" used to describe and claim the present disclosure are intended to be construed in a non- exclusive manner, namely allowing for items, components or elements not explicitly described also to be present. Reference to the singular is also to be construed to relate to the plural where appropriate.

[00056] Although embodiments have been described with reference to a number of illustrative embodiments thereof, it should be understood that numerous other modifications and embodiments can be devised by those skilled in the art that will fall within the spirit and scope of the principles of this disclosure. More particularly, various variations and modifications are possible in the component parts and/or arrangements of the subject combination arrangement within the scope of the present disclosure, the drawings and the appended claims. In addition to variations and modifications in the component parts and/or arrangements, alternative uses will also be apparent to those skilled in the art.
, Claims:WE CLAIM:
1. An integrated pharmaceutical benefits management system 100 comprising of
centralized cloud-based platform 102 to enable real-time synchronization and seamless communication among stakeholders;
data integration module 104 to ensure interoperability with existing healthcare IT systems and maintain consistent data flow;
predictive analytics engine 106 to analyze patient adherence patterns and trigger proactive interventions;
drug cost transparency and comparison module 108 to provide real-time pricing options and cost-saving recommendations for patients;
specialty drug management system 110 to monitor logistics, adherence, and support for high-cost, complex therapies;
value-based contracting system 112 to link reimbursement structures to drug performance and clinical outcomes;
regulatory compliance module 114 to automate adherence to healthcare standards and ensure regulatory alignment;
patient-centric mobile application 116 to offer tools for prescription management, adherence tracking, and communication with stakeholders;
automated prior authorization and eligibility verification system 118 to process insurance benefits and streamline prescription approvals;
real-time reporting and analytics dashboard 120 to generate actionable insights on drug utilization, adherence, and cost trends;
blockchain ledger for data security and audit trail 122 to ensure transparency, integrity, and security of transactions and data;
pharmacogenomics-based dosing module 124 to recommend personalized medication dosages based on genetic profiles;
telepharmacy and virtual consultation platform 126 to facilitate remote counseling and support for patients;
wearable device integration 128 to track medication adherence and provide real-time notifications to patients;
fraud detection and prevention system 130 to monitor for anomalies in prescription and claims data to enhance security;
dynamic copayment optimization engine 132 to calculate and display optimized out-of-pocket costs for patients;
automated therapeutic substitution module 134 to suggest cost-effective and formulary-compliant alternatives for prescribed medications;
drug utilization review system 136 to ensure safety by monitoring prescriptions for interactions and contraindications;
AI-driven drug interaction and polypharmacy monitoring tool 138 to detect and alert for potential safety risks in real-time;
crowdsourced drug pricing feedback system 140 to collect and aggregate real-world pricing data for improved cost transparency; and
medication discontinuation risk prediction engine 142 to identify and address potential therapy discontinuation risks through timely interventions.
2. The integrated pharmaceutical benefits management system 100 as claimed in claim 1, wherein the centralized cloud-based platform 102 is configured to enable real-time synchronization and data sharing among stakeholders, providing a unified ecosystem for healthcare providers, pharmacies, insurers, and patients, ensuring seamless communication and operational efficiency.

3. The integrated pharmaceutical benefits management system 100 as claimed in claim 1, wherein the predictive analytics engine 106 is configured to analyze patient adherence patterns using historical data and machine learning algorithms, triggering targeted interventions through real-time notifications, thereby improving medication adherence and patient outcomes.

4. The integrated pharmaceutical benefits management system 100 as claimed in claim 1, wherein the drug cost transparency and comparison module 108 is configured to provide patients with real-time pricing options, including co-pays, rebates, and discount programs, enabling informed decision-making and reducing out-of-pocket expenses.

5. The integrated pharmaceutical benefits management system 100 as claimed in claim 1, wherein the specialty drug management system 110 is configured to monitor logistics, adherence, and handling requirements for high-cost, complex medications, ensuring compliance with storage guidelines and improving therapeutic outcomes.

6. The integrated pharmaceutical benefits management system 100 as claimed in claim 1, wherein the blockchain ledger for data security and audit trail 122 is configured to ensure the integrity, transparency, and immutability of prescription transactions, claims processing, and patient data through secure decentralized record-keeping.

7. The integrated pharmaceutical benefits management system 100 as claimed in claim 1, wherein the pharmacogenomics-based dosing module 124 is configured to recommend personalized medication dosages based on patient genetic profiles, optimizing therapeutic efficacy and reducing adverse drug reactions.

8. The integrated pharmaceutical benefits management system 100 as claimed in claim 1, wherein the automated prior authorization and eligibility verification system 118 is configured to process insurance coverage and formulary restrictions in real time, reducing administrative delays and expediting medication access.

9. The integrated pharmaceutical benefits management system 100 as claimed in claim 1, wherein the AI-driven drug interaction and polypharmacy monitoring tool 138 is configured to analyse active prescriptions in real-time, detect potential drug-drug interactions, and alert stakeholders to mitigate safety risks and enhance patient care.

10. The integrated pharmaceutical benefits management system 100 as claimed in claim 1, wherein method comprises of
user inputting a prescription into the system via patient-centric mobile application 116 or through healthcare provider integration with data integration module 104;
system automatically verifying patient eligibility and insurance coverage using automated prior authorization and eligibility verification system 118;
verified prescription data being synchronized across stakeholders via centralized cloud-based platform 102 to ensure seamless communication;
predictive analytics engine 106 analyzing patient adherence patterns and triggering reminders or interventions through patient-centric mobile application 116;
drug cost transparency and comparison module 108 providing real-time pricing options, including co-pays and discounts, for the prescribed medication;
specialty drug management system 110 monitoring logistics, storage, and adherence for high-cost specialty medications, if applicable;
drug utilization review system 136 performing real-time safety checks for interactions or contraindications, with any alerts shared via patient-centric mobile application 116;
dynamic copayment optimization engine 132 calculating and displaying optimized out-of-pocket costs for the medication based on discounts and patient income;
blockchain ledger for data security and audit trail 122 securely recording all transactions and interactions to maintain data integrity;
telepharmacy and virtual consultation platform 126 facilitating real-time counseling or support for patients, particularly for specialty medications;
predictive analytics engine 106 collaborating with medication discontinuation risk prediction engine 142 to flag potential discontinuation risks and suggest interventions;
system generating comprehensive reports on adherence, cost trends, and outcomes using real-time reporting and analytics dashboard 120 for stakeholder review;
fraud detection and prevention system 130 monitoring for anomalies in claims and prescription data to enhance security and minimize financial losses;
AI-driven drug interaction and polypharmacy monitoring tool 138 analyzing patient prescriptions in real-time to detect and alert for potential safety risks;
crowdsourced drug pricing feedback system 140 collecting real-world pricing data from patients and refining cost comparison insights;
pharmacogenomics-based dosing module 124 using genetic data to recommend personalized medication dosages for optimized outcomes.

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