Brand vs generic medications Things To Know Before You Buy
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。本発明により、医薬品流通市場における、医療機関・保険薬局といった供給者・処方者と、審査支払機関・保険者・被保険者といった需要者の間で、医療用医薬品の処方・購入に関わる取引に関しリアルタイムに当事者間の合意形成の有無を明確にすることが可能となる。これにより、審査支払機関・保険者は医薬品選択に関わる実効的な意思表示の機会を得ることとなり、自らが希望する医薬品処方につき選択肢が拡大、満足度・費用対効果を向上させることが可能となる。これにより、例えば、審査支払機関がより効能の高い医薬品の処方優先順位を上げることで多くの医療機関で当該医薬品が処方され、結果として被保険者間の医療サービスの質やコストの公平性が促進される。また、同等の効能を持つ複数の医薬品の中で最も安価の医薬品の処方が増加することによる保険者・被保険者の医薬品費用の低減、といった効果も得られる。
【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。
Investigate has confirmed that The share of patients with many medications is rising. So has the necessity for numerous caregivers and/or professional clinical help staff on your supplied personal.
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。
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。
【選択図】図３[Issues] To offer a program for giving an opportunity for any clinical establishment / insurance coverage pharmacy to preferentially adopt a medication that an insured / insurance company or evaluation / payment establishment wishes to prescribe in the health care insurance plan procedure. Provided. [Suggests FOR Resolving Challenges] Coming into / holding information on choices, prescription priority order information of the insurer, and ailments / specifications for approval of the receipt evaluation by an examination / payment institution for a drugs prescribed by an insurance policies health-related establishment Inquiries with regards to no matter if coverage for prescription drugs is accessible for Each and every medical follow in the suggests and professional medical institution, and if the inquiries match the required circumstances with the insurance provider / examination and payment organization determined by personal information including indications of the insured Implies to determine whether the above inquiry information does not match the specified circumstances, look for other drugs that satisfy the desired situations through the drugs specified with the insurance company determined by the insured's information like signs and symptoms A method getting means for notifying a professional medical establishment as a substitute and prompting the health care institution to reselect prescription contents. [Selection] Determine three Description
During the preparation stage of your program, the assessment payer plus the insurer enter needed information and specify conditions. Examples of information entered from the evaluation payer plus the insurance company and the desired ailments are based on information around the insurer matter to evaluation, problems including the insured's age, gender, Structure and earlier record There are assumed health-related charge details calculated for each person sickness and symptom divided, drug cost requirements of used drugs, insurance policies factors, along with other information necessary for examination of health-related charge details.
) offered through the healthcare institution at some time of inquiry and information obtained ahead of time And in real-time if the desired conditions of the insurance provider to whom the insured is affiliated along with the examination and payment Corporation in cost are pleased.
In the prescription information inquiry / distribution program according to claim one, in the event the prescription drugs inquired from the health-related institution for every clinical practice satisfies the selected ailments on the insurer / assessment / payment institution, the tackle in the clinical institution or insured human being Drug prescription information inquiry / distribution procedure that accesses and confirms the dealing with information / inventory information of your drug at quite a few insurance plan pharmacies close to the pharmacy.
Prescriptions is usually a variety used to shop prescribed medication. The shape is beneficial for it helps you track side effects and temper swings connected with the interaction of some medications you have been prescribed.
Initially, in FIG. one, read more the get-togethers linked to the information procedure of the existing creation will probably be clarified. This information method includes a medical establishment that prescribes prescribed drugs on the insured, an insurance policies pharmacy that dispenses pharmaceuticals based on a prescription issued by the clinical institution and provides them into the insured, an insurance company that bears healthcare coverage expenses, and An assessment / payment institution that examines medical cost facts from medical institutions / coverage pharmacies is linked. Each individual get together presents the information program which has a series of necessary information for being explained afterwards.In the information method, (1) information on solutions and prescriptions of the insurer for drugs prescribed through the insurance policies health-related institution to the insured Enter / maintain wanted priority information, (2) Enter / keep situations / expectations for approval of receipt assessment by critique / payment Corporation, (three) Inquire about availability of insurance policies for prescription drugs from health care institutions for every clinical follow Depending on individual information such as acceptance, insured's symptom, medical record, age, and so forth.
provide the most likely of remaining abused, and which could bring about perfectly getting threats from Destructive effects if taken incorrectly,
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