DETAILED ACTION
Notice of Pre-AIA or AIA Status
1. The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA .
Information Disclosure Statement
2. The information disclosure statements (IDS) submitted on 08/01/2025, 08/27/2025, 10/03/2025, 11/06/2025 and 12/17/2025. The submissions are in compliance with the provisions of 37 CFR 1.97. Accordingly, the information disclosure statements are being considered by the examiner.
Claim Objections
3. Objection to claim 7 is withdrawn.
Response to Arguments
4. Applicant filed the amendment on 10/02/2025. Claims 7-18 are pending. Claims 7 and 13 are amended. Claims 7-18 are rejected. After careful consideration of applicant arguments, the examiner finds them to be not persuasive.
Rejections under 35 U.S.C. § 112(b)
5. Rejections of claims 13-18 due to amended claim 13 are withdrawn.
Rejections under 35 U.S.C. § 103
6. Applicant is of the opinion that the prior art references John et al. in view of Harris et al. and Pinsonneault et al. fail to teach or suggest “based on a determination that the response from the pharmacy claims processor is not received within the time threshold, displaying the at least one cash price, and the identifier of the provider of the at least one cash price associated with the cash discount system”.
Applicant arguments are no longer applicable because they are moot in light of the new ground of rejection.
Rejection under 35 USC § 101
7. Applicant’s arguments toward 35 U.S.C. § 101 rejection is not persuasive. Amended independent claims 7 and 13 do not have additional elements that could lead to an improvement in the functioning of a computer, or an improvement to other technology or technical field.
8. Applicant is of the opinion that the claims are not directed to an abstract idea, but to improvements to existing technology.
Examiner respectfully disagrees.
Claims as a whole directed to providing a patient a prescribed medication cash price and associated cash discount which is grouped under “Certain methods of organizing human activity” is similar to commercial interactions.
9. Applicant is of the opinion that the claims integrate the abstract idea into a practical application by listing features of the claimed invention, and concludes that “the monitoring of the network, and automated notification of the medication adherence, provide the meaningful limitations that integrate the alleged abstract idea of human methods and mental processes into the practical application of providing automated notifications regarding prescription costs”.
Examiner respectfully disagrees.
Mentioned above the claim features performed by using the computer components. The use of a processor/computer as a tool to implement the abstract idea does not integrate the abstract idea into a practical application because it requires no more than a computer performing functions that correspond to acts required to carry out the abstract idea. The additional elements do not involve improvements to the functioning of a computer, or to any other technology or technical field (MPEP 2106.05(a)).
Therefore, the claims do not, for example, purport to improve the functioning of a computer. Nor do they effect an improvement in any other technology or technical field. Accordingly, the additional elements do not impose any meaningful limits on practicing the abstract idea, and the claims are directed to the abstract idea.
10. Applicant is of the opinion that “the claims provide significantly more” than the judicial exception, because “they are directed to non-routine and unconventional processes”.
Examiner respectfully disagrees.
The rejection was not based on routine or conventional elements. To the contrary, the claim is directed to the abstract idea of providing a patient a prescribed medication cash price (e.g., (claim 7) “… displaying the at least one cash price, and the identifier of the provider of the at least one cash price …”; (PGPub, para 4) “Methods, apparatuses, and computer program products are therefore provided for supplying a prescriber at the point of prescribing (e.g., during a healthcare service with a patient) with information to provide to a patient, and particularly for providing information relating to cash prices for prescribed drugs at a patient's pharmacy”) and does not improve functioning of a computer or computer technology.
The claims are not patent eligible.
Claim Rejections - 35 USC §101
11. 35 U.S.C. 101 reads as follows:
Whoever invents or discovers any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof, may obtain a patent therefor, subject to the conditions and requirements of this title.
12. Claims 7-18 are rejected under 35 U.S.C. 101 because the claimed invention is directed to a judicial exception (i.e., a law of nature, a natural phenomenon, or an abstract idea) without significantly more.
13. In the instant case, claims 7 and 13 are directed to “an apparatus and at least one non-transitory computer-readable storage medium for providing real-time pricing information”.
14. Claim 7 recites “providing a patient a prescribed medication cash price and associated cash discount”. Specifically, the claim recites “storing a time threshold and a history of cash transactions; receiving … a prescription benefit coverage inquiry associated with a patient, a pharmacy, and a prescribed medication; transmitting the prescription benefit coverage inquiry …; monitoring …to determine whether a response associated with the prescription benefit coverage inquiry is received… within the time threshold; based on the history of cash transactions, determining at least one cash price, associated with … for the prescribed medication at the pharmacy; based on a determination that the response … is received within the time threshold, and the response comprises a patient pay amount that is not null and is non-negative, in real-time or near real-time responsive to receiving the prescription benefit coverage inquiry …: (a) comparing the at least one cash price to prescription benefit information returned in the response …; (b) in an instance the prescription benefit information indicates the patient pay amount is greater than the at least one cash price, displaying the prescription benefit information, the at least one cash price, and an indication of a provider of the at least one cash price associated with …; and (c) in an instance the prescription benefit information indicates a lower than or equal patient pay amount than the at least one cash price, displaying the prescription benefit information; and based on a determination that the response … is not received within the time threshold, displaying the at least one cash price, and the identifier of the provider of the at least one cash price associated with …”. Subject matter grouped under “Certain methods of organizing human activity” (e.g., commercial or legal interactions) and an abstract idea in prong one of step 2A (MPEP 2106.04(a)).
15. This judicial exception is not integrated into a practical application because, when analyzed under prong two of step 2A (MPEP 2106.04 II), the additional elements of the claim 7 such as “at least one processor”, “at least one memory”, “a prescriber computer”, “a pharmacy claims processor computer”, “a communications network”, and “a cash discount system” do no more than represent the use of a computer as a tool to perform an abstract idea and/or generally linking the use of a judicial exception to a particular technological environment or field of use. Therefore, as they do no more than represent the use of a computer as a tool to perform an abstract idea and/or generally linking the use of a judicial exception to a particular technological environment or field of use, they do not improve computer functionality nor improve another technology or technical field. With respect to “storing a time threshold and a history of cash transactions”, “receiving, from a prescriber computer, a prescription benefit coverage inquiry associated with a patient, a pharmacy, and a prescribed medication”, “transmitting the prescription benefit coverage inquiry to a pharmacy claims processor computer”, and “the response from the pharmacy claims processor computer is received within the time threshold”, is simply transmitting data; “[use] of a computer or other machinery in its ordinary capacity for economic or other tasks (e.g., to receive, store, or transmit data) (e.g., a fundamental economic practice or mathematical equation) does not integrate a judicial exception into a practical application or provide significantly more, (MPEP 2106.05(f)(2)).
16. When analyzed under step 2B (MPEP 2106.04 II), the claim does not include additional elements that are sufficient to amount to significantly more than the judicial exception itself. Viewed as a whole, the combination of elements recited in the claim merely describes the concept of providing a patient a prescribed medication cash price and associated cash discount using computer technology (e.g., the processor). Therefore, the use of these additional elements does no more than employ a computer as a tool to automate and/or implement the abstract idea, which cannot provide significantly more than the abstract idea itself (MPEP 2106.05(I)(A)(f) & (h)).
17. Hence, claim 7 is not patent eligible.
18. Claim 13 also recites “providing a patient a prescribed medication cash price and associated cash discount”. Subject matter grouped under “Certain methods of organizing human activity” (e.g., commercial or legal interactions) and an abstract idea in prong one of step 2A (MPEP 2106.04(a)).
19. As in the case of claim 7, the judicial exception is not integrated into a practical application because when analyzed under prong two of step 2A (MPEP 2106.04 II), the additional elements of the claim 13 such as “at least one non-transitory computer-readable storage medium”, “one or more processors”, “a prescriber computer”, “a pharmacy claims processor computer”, “a communications network”, and “a cash discount system” do no more than represent the use of a computer as a tool to perform an abstract idea and/or generally linking the use of a judicial exception to a particular technological environment or field of use. Therefore, as they do no more than represent the use of a computer as a tool to perform an abstract idea and/or generally linking the use of a judicial exception to a particular technological environment or field of use, they do not improve computer functionality nor improve another technology or technical field. With respect to “storing a time threshold and a history of cash transactions”, “receiving from a prescriber computer, a prescription benefit coverage inquiry associated with a patient, a pharmacy, and a prescribed computer”, “transmitting the prescription benefit coverage inquiry to a pharmacy claims processor computer for processing”, and “the response from the pharmacy claims processor computer is received within the time threshold”, is simply transmitting data; “[use] of a computer or other machinery in its ordinary capacity for economic or other tasks (e.g., to receive, store, or transmit data) (e.g., a fundamental economic practice or mathematical equation) does not integrate a judicial exception into a practical application or provide significantly more, (MPEP 2106.05(f)(2)).
20. When analyzed under step 2B (MPEP 2106.04 II), the claims do not include additional elements that are sufficient to amount to significantly more than the judicial exception itself. Viewed as a whole, the combination of elements recited in the claims merely describe the concept of providing a patient a prescribed medication cash price and associated cash discount using computer technology (e.g., the processor). Therefore, the use of these additional elements does no more than employ a computer as a tool to automate and/or implement the abstract idea, which cannot provide significantly more than the abstract idea itself (MPEP 2106.05(I)(A)(f) & (h)).
21. Hence, claim 13 is not patent eligible.
22. Dependent claims 8 and 14 further describe the abstract idea of providing a patient a prescribed medication cash price and associated cash discount, as each recites “further in an instance the prescription benefit information indicates a lower than or equal price to the at least one cash price … the at least one cash price”. The additional element such as “precluding display” represents the use of a computer as a tool to perform an abstract idea and do no more than generally link the abstract idea to a particular field of use. And, therefore, do not improve the functioning of a computer, or to any other technology or technical field.
Dependent claims 9 and 15 further describe the abstract idea of providing a patient a prescribed medication cash price and associated cash discount, as each recites “receiving a plurality of records … pertaining to cash transactions …; and storing the plurality of records as historical data for subsequent access, wherein the cash transaction history accessed to determine the at least one cash price for the prescribed medication at the pharmacy is accessed from the stored historical data”. The additional elements such as “a plurality of pharmacy computers” and “a plurality of cash discount systems” represent the use of a computer as a tool to perform an abstract idea and do no more than generally link the abstract idea to a particular field of use. And, therefore, do not improve the functioning of a computer, or to any other technology or technical field.
Dependent claims 10 and 16 further describe the abstract idea of providing a patient a prescribed medication cash price and associated cash discount, as each recites “wherein at least one of the prescription benefit information, the at least one cash price, or … relative to transmission of the prescription benefit coverage inquiry …”. The additional elements such as “the associated cash discount system of the at least one cash price is displayed at the prescriber computer in real-time or near real-time” and “the prescriber computer” represent the use of a computer as a tool to perform an abstract idea and do no more than generally link the abstract idea to a particular field of use. And, therefore, do not improve the functioning of a computer, or to any other technology or technical field.
Dependent claims 11 and 17 further describe the abstract idea of providing a patient a prescribed medication cash price and associated cash discount, as each recites “wherein determining the at least one cash price for the prescribed medication at the pharmacy comprises accessing a plurality of cash transaction records associated with …”. The additional element such as “different cash discount systems” represents the use of a computer as a tool to perform an abstract idea and do no more than generally link the abstract idea to a particular field of use. And, therefore, do not improve the functioning of a computer, or to any other technology or technical field.
Dependent claims 12 and 18 further describe the abstract idea of providing a patient a prescribed medication cash price and associated cash discount, as each recites “wherein determining the at least one cash price for the prescribed medication at the pharmacy comprises assessing pharmacy revenue and an amount to be paid by the patient”.
Conclusion
23. The claims as a whole do not amount to significantly more than the abstract idea itself. This is because the claims do not effect an improvement to another technology or technical field; the claims do not amount to an improvement to the functioning of a computer system itself; and the claims do not move beyond a general link of the use of an abstract idea to a particular technological environment.
24. Accordingly, there are no meaningful limitations in the claims that transform the judicial exception into a patent eligible application such that the claims amount to significantly more than the judicial exception itself.
Claim Rejections - 35 USC § 103
25. In the event the determination of the status of the application as subject to AIA 35 U.S.C. 102 and 103 (or as subject to pre-AIA 35 U.S.C. 102 and 103) is incorrect, any correction of the statutory basis for the rejection will not be considered a new ground of rejection if the prior art relied upon, and the rationale supporting the rejection, would be the same under either status.
26. The following is a quotation of 35 U.S.C. 103 which forms the basis for all obviousness rejections set forth in this Office action:
A patent for a claimed invention may not be obtained, notwithstanding that the claimed invention is not identically disclosed as set forth in section 102, if the differences between the claimed invention and the prior art are such that the claimed invention as a whole would have been obvious before the effective filing date of the claimed invention to a person having ordinary skill in the art to which the claimed invention pertains. Patentability shall not be negated by the manner in which the invention was made.
27. The factual inquiries for establishing a background for determining obviousness under 35 U.S.C. 103 are summarized as follows:
1. Determining the scope and contents of the prior art.
2. Ascertaining the differences between the prior art and the claims at issue.
3. Resolving the level of ordinary skill in the pertinent art.
4. Considering objective evidence present in the application indicating obviousness or nonobviousness.
28. Claims 7-18 are rejected under 35 U.S.C. 103 as being unpatentable over US20120253846A1 to John et al. in view of US10423759B1 to Harris et al., US8538777B1 to Kaye et al., and US10565656B1 to Pinsonneault et al.
29. As per claims 7 and 13:
John et al. discloses the following limitations:
at least one processor (Fig.2, item 219; [0061])
at least one memory (Fig.2, item 212; [0061])
receiving, from a prescriber computer, a prescription benefit coverage inquiry associated with a patient, a pharmacy, and a prescribed medication (Fig.4, item 405; [0060] “First, the healthcare provider computer 202 may be associated with a healthcare provider 110 such as a physician, physician group, hospital, or other prescriber of a drug or product. The healthcare provider computer 202 may be any suitable processor-driven device that facilitates the generation and delivery of healthcare transaction requests or electronic prescriptions to a service provider computer 204 or to a pharmacy computer 203, either directly or through the service provider computer 204…”; [0104] “At block 405, the service provider computer 204 and/or virtual pharmacy module 205 may receive an electronic prescription 302 from either a healthcare provider 110 or a patient 115…”)
transmitting the prescription benefit coverage inquiry to a pharmacy claims processor computer ([0063] “…a user such as a physician or prescriber may utilize the client module 222 in preparing and delivering a healthcare transaction request or an electronic prescription to the appropriate service provider computer 204 and/or pharmacy computer 203…”; [0065] “…The pharmacy computer 203 may be any suitable processor-driven device that facilitates the receipt and processing of healthcare transaction requests or electronic prescriptions from a healthcare provider computer 202 and/or a service provider computer 204. The pharmacy computer 203 can also facilitate the generation or processing of any billing or reimbursement claim transactions that are associated with electronic prescriptions, including the generation and delivery of reimbursement healthcare claims to a financial processing computer 208 for adjudication…”)
monitoring a communication network … a response associated with the prescription benefit coverage inquiry is received from the pharmacy claims processor computer … ([0067] “The data files 258 may include any suitable data that facilitates the receipt and/or processing of healthcare transaction requests or prescription orders and the generation and/or processing of any billing or reimbursement claim transactions associated with electronic prescriptions…”; [0068] “The client module 252 may include an interface, such as a dedicated software program and/or an Internet browser, for interacting with the healthcare provider computer 202, the service provider computer 204, the patient device/computer 206, the financial processing computer 208, or any other component of the healthcare system 200…The pharmacy computer 203 may also utilize the client module 252 to retrieve or otherwise receive data or responses from the healthcare provider computer 202 and/or the service provider computer 204.” [0073] “…the PPE module 233 may be operable to perform one or more post-edits on a reply or response that is received from a financial processing computer 208 or pharmacy computer 203 prior to routing a corresponding reply or response to the originating computer such as the healthcare provider computer 202 or the patient device/computer 206…”)
[based] … determining at least one cash price, associated with cash discount system, for the prescribed medication at the pharmacy ([0072] “According to an embodiment of the invention, the data files 234 may store healthcare transaction records associated with communications received from various healthcare provider computers 202, pharmacy computers 203, patient devices/computers 206, financial processing computers 208, or any other components of the healthcare system 200”, [0153] “… block 435 may also determine cash costs or prices for filling prescriptions at one or more pharmacies 120 a-n, according to an example embodiment of the invention.” [0155] “…Block 445 may calculate an extent to which any incentives or penalties apply for filling the prescription at one or more identified actual/dispensing pharmacies 120 a-n. For example, block 445 can determine a monetary amount of any financial incentives (or penalties) that apply for filling the prescription at one or more dispensing pharmacies 120 a-n….”)
[based] … in real-time or near real-time responsive to receiving the prescription benefit coverage inquiry from the prescriber computer (Fig.7, items 710, 715; [0068] “… The pharmacy computer 203 may also utilize the client module 252 to retrieve or otherwise receive data or responses from the healthcare provider computer 202 and/or the service provider computer 204.”, [0204] “… With real-time pricing, a service provider computer 204 and/or virtual pharmacy module 205 may communicate in real-time with a computer associated with a pharmacy 120 a-n or a payor 125. Accordingly, block 710 may determine, based upon the selected pharmacy 120 a-n or a payor associated with patient 115, whether real-time pricing is available.”, [0205] “…At block 715, the service provider computer 204 and/or virtual pharmacy module 205 may generate a healthcare transaction request (e.g., NCPDP transaction, EDI transaction, etc.) inquiring about a cost of filling a prescription at a pharmacy 120 a-n…”)
(a) comparing the at least one cash price to prescription benefit information (Fig. 14, [0164] “… FIG. 14 illustrates an example user interface 1400 of software used on a patient device/computer 206 that is a mobile device, smart phone, or personal communications device. As shown in the example user interface 1400, there is displayed or presented a list of pharmacies in conjunction with associated information that includes: … (ii) total price or cost information (e.g., Total Cost) for each dispensing pharmacy 120 a-n, and (iii) patient payable cost (e.g., Your Cost) for each dispensing pharmacy 120 a-n. … the user interface 1400 could have also shown incentive or penalty/disincentive information or utilized different color coding or other indicia to identify those pharmacies recommended or not recommended for selection …”) returned in the response from the pharmacy claims processor computer ([0201] “… this scenario may be considered as a payor under consideration so that the cash customer cost can likewise be determined at one or more pharmacies or pharmacy locations 120 a-n, according to an example embodiment of the invention. Accordingly, at block 702, a payor can be selected for purposes of determining costs or prices for filling the prescription at one or more pharmacies.”, [0216] “… Block 745 may include obtaining cost data from the available industry pricing. In some example embodiments of the invention, it will be appreciated that industry pricing figures may be helpful in estimating total costs at one or more retail pharmacies… the industry pricing figures may be helpful in comparing retail pharmacies to non-retail pharmacies such as one or more mail-order pharmacies…”)
(b) in an instance the prescription benefit information indicates the patient pay amount is greater than the at least one cash price, displaying the prescription benefit information, the at least one cash price, and an indication of a provider of the at least one cash price associated with the cash discount system (Fig.8, items 810, 825, 830; [0099] “The one or more I/O interfaces 290 may facilitate communication between the financial processing computer 208 and one or more input/output devices, for example, one or more user interface devices, such as a display, keypad, control panel, touch screen display, remote control, microphone, etc., that facilitate user interaction with the financial processing computer 208.”, [0227] “… At block 810, a percentage of the total price or cost of the drug or product may be obtained. It will be appreciated that this total price or cost may have been determined …”, [0228] “… in some embodiments, the calculated percentage amount at block 810 may be modified, perhaps subject to minimum or maximum patient payable amounts, for purposes of the patient payable amount….”, [0230] “…. Block 825 may determine whether the calculated percentage amount exceeds a maximum patient payable amount. It will be appreciated that the maximum payable amount can be set to a high number or infinite value, which effectively results in there being no maximum patient payable amount… If the calculated percentage amount is greater than the maximum patient payable amount, then processing may proceed to block 830, where the patient payable amount may be set to the maximum patient payable amount.”)
(c) in an instance the prescription benefit information indicates a lower than or equal patient pay amount than the at least one cash price, displaying the prescription benefit information (Fig.8, items 810, 815, 820; [0099] “The one or more I/O interfaces 290 may facilitate communication between the financial processing computer 208 and one or more input/output devices, for example, one or more user interface devices, such as a display, keypad, control panel, touch screen display, remote control, microphone, etc., that facilitate user interaction with the financial processing computer 208.”, [0227] “… At block 810, a percentage of the total price or cost of the drug or product may be obtained. It will be appreciated that this total price or cost may have been determined, for the selected payor and/or pharmacy location…”, [0228] “… the calculated percentage amount at block 810 may be used as the patient payable amount…”, [0229] “… If the calculated percentage amount is less than a minimum patient payable amount, then processing may proceed to block 820, where the patient payable amount may be set to be the minimum patient payable amount.”)
[based] … displaying the at least one cash price, (Fig.14, [0164] “For example, FIG. 14 illustrates an example user interface 1400 of software used on a patient device/computer 206 that is a mobile device, smart phone, or personal communications device. As shown in the example user interface 1400, there is displayed or presented a list of pharmacies in conjunction with associated information that includes: … (ii) total price or cost information (e.g., Total Cost) for each dispensing pharmacy 120 a-n, and (iii) patient payable cost (e.g., Your Cost) for each dispensing pharmacy 120 a-n…”) and the identifier of the provider of the at least one cash price associated cash discount system (Fig.7, items 750, 755; [0218] “… Block 750 may determine whether any other price or cost determination method is available for determining the price or cost of filling a prescription at the selected pharmacy 120 a-n. For example, an alternative price or cost determination method may include contacting another data aggregator to inquire about the cost of filling a prescription drug or product at a selected pharmacy 120 a-n. If block 750 determines that alternate pricing is available, then processing may proceed to block 755, where the alternate price or cost determination method may be executed to determine the price or cost of filling the prescription at the selected pharmacy 120 a-n…”)
John et al. does not disclose, however, Harris et al., as shown, teach the following limitations:
storing a time threshold… (Col.4, lines 47-49 “… the rejection claims database 182 or another database may include time threshold limits”, col.8, lines 51-56 “The exemplary data files 148 may also store records containing, for example, patient identification data, healthcare transactions, tables identifying healthcare providers, the predetermined time threshold limits from which the receipt of healthcare transactions can be inferred as a request”)
[monitoring] … to determine whether a response … is received … within the time threshold (Col.21, lines 45-49 “another portion of the service provider computer 106 can compare the determined submission time difference to a time limit threshold to determine if the submission time difference is within (or otherwise satisfies) the time limit threshold.”)
based on a determination that the response from the pharmacy claims processor computer is received within the time threshold (Col.21, lines 45-49 “another portion of the service provider computer 106 can compare the determined submission time difference to a time limit threshold to determine if the submission time difference is within (or otherwise satisfies) the time limit threshold.”)
based on a determination that the response from the pharmacy claims processor is not received within the time threshold… (Col.26, lines 22-27 “The determination can be made by the prior authorization logic module 180 or another portion of the service provider computer 106 and can be done by comparing the submission time difference to the time limit threshold. If the submission time difference is not within the time limit threshold.”)
It would have been obvious to one of ordinary skill in the art before the effective filing date of the claimed invention to incorporate a system and methods of transaction submission time for each of the received healthcare transaction and stored healthcare transaction can be received and compared to one another to determine a submission time difference between the submission time for the healthcare transaction and the stored healthcare transaction of Harris et al. (‘759, abstract) with teaching of John et al. of receiving an electronic prescription associated with a patient and determining a respective total price payable to each of the plurality of dispensing pharmacies for filling the prescribed drug (‘846, [0007]) for storing time threshold limits, comparing submission time difference to a time limit threshold to determine if the submission time difference is within the time limit threshold or not (‘759, col.4, lines 47-49; col.21, lines 45-49; col.26, lines 22-27).
John et al., nor Harris et al. disclose, however, Kaye et al., as shown, teach the following limitations:
storing … a history of cash transactions (Col.6, lines 30-34 “the medication history database 138 may be utilized to store information associated with a wide variety of different types of pharmacy claims transactions, including but not limited to, insurance claims transactions, credit card transactions, check transactions, and/or cash transactions”)
based on the history of cash transactions … (Col.10, lines 10-13 “The medication history databases 190 associated with the various third party data sources 114 may include information associated with pharmacy claims transactions, pharmacy cash transactions, and/or other pharmacy transactions.”)
It would have been obvious to one of ordinary skill in the art before the effective filing date of the claimed invention to incorporate a system and methods of transaction submission time for each of the received healthcare transaction and stored healthcare transaction can be received and compared to one another to determine a submission time difference between the submission time for the healthcare transaction and the stored healthcare transaction of Harris et al. (‘759, abstract) and systems and methods for capturing patient medication history and providing the patient medication history to a healthcare service provider, such as, a hospital, doctor's office, clinician, etc. of Kaye et al. (‘777, col.3, lines 39-42) with teaching of John et al. of receiving an electronic prescription associated with a patient and determining a respective total price payable to each of the plurality of dispensing pharmacies for filling the prescribed drug (‘846, [0007]) for storing information associated with a wide variety of different types of pharmacy claims transactions, including cash transactions (‘777, col.6, lines 30-34).
John et al., nor Harris et al. or Kaye et al. disclose, however, Pinsonneault et al., as shown, teach the following limitations:
[based] … and the response comprises a patient pay amount that is not null and is non-negative … (Fig.3B, items 352, 382; col.20, lines 45-50 “In one example embodiment, the determination can be made by the discount evaluation module 180 or another portion of the service provider computer 106. In one example, the discount evaluation module 180 may compare the identified total amount paid from the Total Amount Paid field to a zero value to determine if the amount is greater than the zero value. If the amount in the Total Amount Paid field is greater than zero, the NO branch is followed to step 382.”)
It would have been obvious to one of ordinary skill in the art before the effective filing date of the claimed invention to incorporate a system and methods of transaction submission time for each of the received healthcare transaction and stored healthcare transaction can be received and compared to one another to determine a submission time difference between the submission time for the healthcare transaction and the stored healthcare transaction of Harris et al. (‘759, abstract), systems and methods for capturing patient medication history and providing the patient medication history to a healthcare service provider, such as, a hospital, doctor's office, clinician, etc. of Kaye et al. (‘777, col.3, lines 39-42), and a method for conducting audit evaluation by comparing the patient pay amount to the Usual and Customary Charge amount and determining the amount being less than or less than or equal to the patient pay amount of Pinsonneault et al. (‘656, abstract) with teaching of John et al. of receiving an electronic prescription associated with a patient and determining a respective total price payable to each of the plurality of dispensing pharmacies for filling the prescribed drug (‘846, [0007]) for enabling determination whether the identified total amount paid is greater than the zero value (‘656, col.20, lines 45-50).
As per claim 13 John et al. additionally discloses the following limitations:
at least one non-transitory computer-readable storage medium ([0058])
one or more processors (Fig.2, item 219; [0061])
30. As per claims 8 and 14:
John et al. discloses the following limitations:
further in an instance the prescription benefit information indicates a lower than or equal price to the at least one cash price, precluding display of the at least one cash price (Fig.8, items 815, 820; [0099] “The one or more I/O interfaces 290 may facilitate communication between the financial processing computer 208 and one or more input/output devices, for example, one or more user interface devices, such as a display, keypad, control panel, touch screen display, remote control, microphone, etc., that facilitate user interaction with the financial processing computer 208.”, [0229] “…block 815 may determine whether the calculated percentage amount is less than a minimum patient payable amount. It will be appreciated that the minimum patient payable amount can be set to zero, which effectively results in there being no minimum patient payable amount…block 820, where the patient payable amount may be set to be the minimum patient payable amount.”)
31. As per claims 9 and 15:
John et al. discloses the following limitations:
storing the plurality of records as historical data for subsequent access, wherein the cash transaction history accessed to determine the at least one cash price for the prescribed medication at the pharmacy is accessed from the stored historical data ([0072] “… the data files 234 may store healthcare transaction records associated with communications received from various healthcare provider computers 202, pharmacy computers 203, patient devices/computers 206, financial processing computers 208, or any other components of the healthcare system 200….”, [0081] “… the virtual pharmacy module 205 may access, or otherwise receive information from, the database 242 and/or the data files 234…”, [0210] “…Block 730 may determine whether historical pricing information is available for filling the prescription at the selected pharmacy 120 a-n …”, [0211] “… At block 735, the service provider computer 204 and/or virtual pharmacy module 205 may obtain cost or pricing information using the available historical pricing information…”)
John et al. does not disclose, however, Kaye et al., as shown, teach the following limitations:
receiving a plurality of records from a plurality of pharmacy computer pertaining to cash transactions via a plurality of cash discount systems (Col.10, lines 10-17 “The medication history databases 190 associated with the various third party data sources 114 may include information associated with pharmacy claims transactions, pharmacy cash transactions, and/or other pharmacy transactions. The pharmacy claims transaction may be transactions that are processed by the third party data sources 114, switched or routed through the third party data sources 114, and/or adjudicated by the third party data sources 114.”)
It would have been obvious to one of ordinary skill in the art before the effective filing date of the claimed invention to incorporate a system and methods of transaction submission time for each of the received healthcare transaction and stored healthcare transaction can be received and compared to one another to determine a submission time difference between the submission time for the healthcare transaction and the stored healthcare transaction of Harris et al. (‘759, abstract) and systems and methods for capturing patient medication history and providing the patient medication history to a healthcare service provider, such as, a hospital, doctor's office, clinician, etc. of Kaye et al. (‘777, col.3, lines 39-42) with teaching of John et al. of receiving an electronic prescription associated with a patient and determining a respective total price payable to each of the plurality of dispensing pharmacies for filling the prescribed drug (‘846, [0007]) for receiving information associated with a wide variety of different types of pharmacy claims transactions from various third party data sources (‘777, col.10, lines 10-17).
32. As per claims 10 and 16:
John et al. discloses the following limitations:
wherein at least one of the prescription benefit information, the at least one cash price, or the associated cash discount system of the at least one cash price is displayed at the prescriber computer in real-time or near real-time relative to transmission of the prescription benefit coverage inquiry by the prescriber computer ([0026] “…the virtual pharmacy can perform one or more real-time processes to determine actual/dispensing pharmacies that meet the location preferences and/or healthcare plan “in-network” requirements of the patient or customer, as well as determine cost/pricing (and/or incentive) information associated with filling the prescription at one or more of the dispensing pharmacy locations…”, [0099] “The one or more I/O interfaces 290 may facilitate communication between the financial processing computer 208 and one or more input/output devices, for example, one or more user interface devices, such as a display, keypad, control panel, touch screen display, remote control, microphone, etc., that facilitate user interaction with the financial processing computer 208.”)
33. As per claims 11 and 17:
John et al. discloses the following limitations:
wherein determining the at least one cash price for the prescribed medication at the pharmacy comprises accessing a plurality of cash transaction records associated with different cash discount systems (Fig.4, items 435, 440, 445; [0153] “… block 435 may also determine cash costs or prices for filling prescriptions at one or more pharmacies 120 a-n …”, [0154] “… At block 440, the service provider computer 204 and/or virtual pharmacy module 205 can determine whether any incentives (or penalties) are available for filling the prescription at any of the identified dispensing pharmacies 120 a-n…”, [0155] “…block 445 can determine a monetary amount of any financial incentives (or penalties) that apply for filling the prescription at one or more dispensing pharmacies 120 a-n…”)
34. As per claims 12 and 18:
John et al. discloses the following limitations:
wherein determining the at least one cash price for the prescribed medication at the pharmacy comprises assessing pharmacy revenue and an amount to be paid by the patient ([0095] “The financial processing computer 208 may be a healthcare claims processor computer for a payor 125 or another processing computer associated with a financial processor 130. As an example, there may be a first financial processing computer 208 that operates as a healthcare claims processor computer for adjudicating healthcare claims to determine benefits and/or coverage, including determining covered amounts payable by a payor to a healthcare provider or pharmacy, as well as patient payable amounts (e.g., co-pay amount or co-insurance amounts)…”, [0153] “…it may be necessary at block 435 to determine, for each payor 125, respective prices or costs for filling a prescription at the one or more dispensing pharmacies 120 a-n. Likewise, as described herein, block 435 may also determine cash costs or prices for filling prescriptions at one or more pharmacies 120 a-n …”, [0172] “…the financial processing can result in payments being delivered directly to an account of the pharmacy 120 a-n to cover a total amount payable to a pharmacy 120 a-n for providing the requested drug or product to the patient 115…”)
Conclusion
35. The prior art made of record and not relied upon is considered pertinent to applicant's disclosure.
US10262383B1 – Harris et al. – Discloses systems and methods for determining the operational status of third-party switch/service providers, wherein the service provider computer receives healthcare transactions and determines if each transaction is to be processed by a third-party switch provider system, either under a contract between the pharmacy and the third-party switch provider or under an exclusivity arrangement between the transaction payer and the third-party switch provider.
US20150371000A1 – Pinsonneault – Discloses systems and methods for determining patient adherence to a medication protocol by evaluating healthcare transactions, wherein an e-prescription transaction can be received from a prescriber and evaluated to determine if the patient is to receive adherence analysis.
US20070043595A1 – Pederson – Discloses a system and method for estimating medical costs under at least one health plan, one or more user devices provide user health data entered by one or more users to a processor, and the processor provides estimated health plan cost data to the user device(s) to enable the user(s) to compare the costs and benefits of various health plan options available to the user(s).
36. Applicant's amendment necessitated the new ground(s) of rejection presented in this Office action. Accordingly, THIS ACTION IS MADE FINAL. See MPEP § 706.07(a). Applicant is reminded of the extension of time policy as set forth in 37 CFR 1.136(a).
A shortened statutory period for reply to this final action is set to expire THREE MONTHS from the mailing date of this action. In the event a first reply is filed within TWO MONTHS of the mailing date of this final action and the advisory action is not mailed until after the end of the THREE-MONTH shortened statutory period, then the shortened statutory period will expire on the date the advisory action is mailed, and any nonprovisional extension fee (37 CFR 1.17(a)) pursuant to 37 CFR 1.136(a) will be calculated from the mailing date of the advisory action. In no event, however, will the statutory period for reply expire later than SIX MONTHS from the mailing date of this final action.
37. Any inquiry concerning this communication or earlier communications from the examiner should be directed to AMANULLA ABDULLAEV whose telephone number is (571)272-4367. The examiner can normally be reached Monday-Friday 9:30AM -4:30PM ET.
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/AMANULLA ABDULLAEV/Examiner, Art Unit 3692
/RYAN D DONLON/Supervisory Patent Examiner, Art Unit 3692 February 2, 2026