DETAILED ACTION
Notice of Pre-AIA or AIA Status
The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA .
Status of Claims
This Nonfinal Office Action is in response to the RCE filed 07/06/2026. Claims 1, 3, 6, 13 and 19-20 are amended. Claims 1 and 3-20 are pending and considered herein.
Continued Examination Under 37 CFR 1.114
A request for continued examination under 37 CFR 1.114, including the fee set forth in 37 CFR 1.17(e), was filed in this application after final rejection. Since this application is eligible for continued examination under 37 CFR 1.114, and the fee set forth in 37 CFR 1.17(e) has been timely paid, the finality of the previous Office action has been withdrawn pursuant to 37 CFR 1.114. Applicant's submission filed on 07/06/2025 has been entered.
Claim Rejections - 35 USC § 101
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.
Claims 1 and 3-20 are rejected under 35 U.S.C. §101 because they recite an abstract idea without significantly more.
Claim 1 recites, wherein the abstract idea is not emboldened:
A computerized method comprising: receiving, by a first server associated with a first claim adjudication entity, a claim for a prescription drug for a patient, the first claim adjudication entity managing a prescription drug profile for the patient; electronically accessing initial fulfillment information for fulfilling the prescription drug using the first claim adjudication entity; determining, using the first server, that one or more features associated with the prescription drug of the claim correspond to one or more criteria, wherein the determining that the one or more features correspond to the one or more criteria includes receiving input from the patient for opting into an alternate claim adjudication process comprising communication with a second server associated with a second claim adjudication entity; wherein the determining that the one or more features correspond to the one or more criteria includes applying a machine learning model to the one or more features associated with the prescription drug to predict a likelihood that the alternate fulfillment information of the second server outranks the initial fulfillment information; conditioning transmission of the communication to the second server on the likelihood transgressing a threshold; in response to determining that one or more features associated with the prescription drug of the claim correspond to the one or more criteria, transmitting a communication to the second server associated with the second claim adjudication entity, the communication identifying the prescription drug and requesting alternate fulfillment information; and selecting a claim adjudication process based on the initial fulfillment information and the alternate fulfillment information.
Independent claims 6, 13, 19 and 20 include substantially the same limitations and further include a “system” with “one or more processors coupled to a memory comprising non-transitory computer instructions,” (Claim 19), CRM (Claim 20), and neural network (Claim 6), all of which are recited at a high level of generality, and even in combination do not provide a practical application integrated in the claims or significantly more than the abstract idea. The claimed invention is broadly directed to the abstract idea of collecting patient prescription drug information, analyzing the information, and determining adjudication and fulfillment processes related to the patient and drug information based on the analyses.
The limitations of “receiving, associated with a first claim adjudication entity, a claim for a prescription drug for a patient, the first claim adjudication entity managing a prescription drug profile for the patient; accessing initial fulfillment information for fulfilling the prescription drug using the first claim adjudication entity; determining that one or more features associated with the prescription drug of the claim correspond to one or more criteria, wherein the determining that the one or more features correspond to the one or more criteria includes receiving input from the patient for opting into an alternate claim adjudication process comprising communication with a second claim adjudication entity; wherein the determining that the one or more features correspond to the one or more criteria to the one or more features associated with the prescription drug to predict a likelihood that the alternate fulfillment information outranks the initial fulfillment information; in response to determining that one or more features associated with the prescription drug of the claim correspond to the one or more criteria, a communication associated with a second claim adjudication entity, the communication identifying the prescription drug and requesting alternate fulfillment information; and selecting a claim adjudication process based on the initial fulfillment information and the alternate fulfillment information,” as drafted, is a process that, under its broadest reasonable interpretation, is an abstract idea that covers performance of the limitation as certain methods of organizing human activity. For example, but for the generic servers where data are conditionally transmitted/communicated, and the generic “computerized method,” computer processor and memory, non-transitory computer-readable instructions, neural networks and machine learning models, analyzing patient prescription data and determining a fulfilled prescription claim adjudication process based on the analyses, in the context of this claim, is an abstract idea including a healthcare provider following rules or instructions.
This judicial exception is not integrated into a practical application. In particular, the claim recites the additional elements of being implemented by generic servers where data are transmitted/communicated, and the generic computer processor and memory and non-transitory computer-readable instructions for the sending and receiving and calculation of information, and including using neural networks and machine learning models related to a patient’s prescription claim and fulfillment data. The devices in these steps are recited at a high-level of generality (i.e., as a generic processor/server/storage/display performing a generic computer function of receiving inputs, analyzing the inputs, and displaying selected information) such that it amounts no more than mere instructions to apply the exception using a generic computer component. Accordingly, these additional elements, alone or in combination, do not integrate the abstract idea into a practical application because they do not impose any meaningful limits on practicing the abstract idea. The limitations appear to monopolize the abstract idea of patient prescription analysis and general claim adjudication and fulfillment techniques for a clinician and patient. Furthermore, there is no clear improvement to the underlying computer technology in the claim. The claim is thus directed to an abstract idea.
The claims do not include additional elements that are sufficient to amount to significantly more than the judicial exception. As discussed above with respect to integration of the abstract idea into a practical application, the additional elements of being implemented by generic servers where data are transmitted/communicated, and the generic computer processor and memory, non-transitory computer-readable instructions, and machine learning model/neural network amounts to no more than mere instructions to apply the exception using a computer component. Mere instructions to apply an exception using a generic computer component cannot provide an inventive concept. Therefore, when considering the additional elements alone, and in combination, there is no inventive concept in the claim, and thus the claim is not patent eligible.
The dependent claims do not remedy the deficiencies of the independent claims with respect to patent eligible subject matter. The dependent claims further limit the abstract idea and do not overcome the rejection under 35 U.S.C. §101. Claim 3 describes presenting on a client device certain alternate claim adjudication entities, which are recited at a high level of generality such that they amount no more than mere instructions to apply the judicial exception using a generic computer component and cannot provide an inventive concept. Even in combination, presenting, on a client device, alternate claim adjudication entities does not integrate the abstract idea into a practical application and does not amount to significantly more than the abstract idea itself. Claim 4 describes transmitting communications about claim adjudication entities to the servers and identifying prescription fulfillment information and is recited at a high level of generality such that it amounts to no more than mere instructions to apply the judicial exception using a generic computer component and does not provide a practical application that is integrated in the claims or significantly more than the abstract idea. Claim 5 describes a ranking model which is recited at a high level of generality such that it amounts to no more than mere instructions to apply the judicial exception using a generic computer component and cannot provide an inventive concept. Even in combination, the ranking model does not integrate the abstract idea into a practical application and does not amount to significantly more than the abstract idea itself. Claim 7 describes a machine learning model and a neural network which are recited at a high level of generality such that they amount to no more than mere instructions to apply the judicial exception using a generic computer component and cannot provide an inventive concept. Even in combination, the machine learning model and neural network does not integrate the abstract idea into a practical application and does not amount to significantly more than the abstract idea itself. Claim 7 further defines the training of the machine learning model to “generate and estimated risk” and for “computing a loss based on a deviation between the estimated rank and the ground truth likelihoods.” These are merely instructions provided to apply the abstract idea using the generic machine learning model and cannot provide an inventive concept. Claim 8 describes features corresponding to fulfillment criteria and other details and further limits the abstract idea. Claim 9 describes a timer and timed data that is communicated and further limits the abstract idea. Claims 10-12 detail initial or alternate fulfillment information and related responses and limits the abstract idea. Claims 14-15 details a drug profile, drug interactions and adjudication responses and limits the abstract idea. Claim 16 describes communication via an intermediate hub, which is recited at a high level of generality such that it amounts no more than mere instructions to apply the judicial exception using a generic computer component and cannot provide an inventive concept. Even in combination, the intermediate hub does not integrate the abstract idea into a practical application and does not amount to significantly more than the abstract idea itself. Claim 17 further describes the drug profile and related data and limits the abstract idea. Claim 18 describes the fulfillment information and modifications thereto and limits the abstract idea. For at least these reasons and those stated above the claims are not patent eligible.
Response to Arguments
Applicant’s remarks filed July 6, 2026 have been fully considered, but they are not persuasive. The following explains why:
Applicant’s arguments pertaining to subject matter eligibility are not persuasive. The claims have been addressed with regard to the updated 35 U.S.C. §101 rejection discussed above and considered under the relevant sections of the MPEP. The arguments at pages 11-14 of Applicant’s Remarks are not persuasive. At pages 11-13, the Examiner disagrees that there is not an abstract idea, that there is any practical application thereof and there is a technological improvement recited in the claims. The claims are directed to the abstract idea of organizing human activity, discussed above. The basis for the rejection under 35 U.S.C. §101 is still operative. The activity of comparing claim adjudication processes and making an appropriate selection is a human activity that can be performed by a person using the computer and machine learning as additional elements and/or tool to apply the abstract idea, without significantly more. It comprises a human act of following rules or instructions as a pharmacist or health care entity would perform in the practice of prescribing medication. The server-to-server communication (argued at Page 12) is an additional element, and not part of the abstract idea. The server-to-server communication is an additional element, as discussed, and does not provide a practical application that is integrated in the claims or significantly more than the abstract idea, therefore the claims are directed to an abstract idea (judicial exception). The Examiner disagrees with arguments at pages 12-13 that independent claim 6 recites practical application for the machine learning model and neural network However, these recitations are not clearly an improvement to the underlying computer technology, and furthermore the machine learning and neural network act merely is an additional element that is utilized to apply the abstract idea, without more, and therefore the claim recites an abstract idea. The Examiner disagrees at Pages 12-13 that limitations of claim 7 overcome the rejection under 35 U.S.C §101. Claim 7 also recites the machine learning and neural network at a high level of generality and does not provide a practical application that is integrated in the claims or significantly more than the abstract idea. The “machine learning model,” and “training prescription drug features by the machine learning model to generate an estimated rank; computing a loss based on a deviation between the estimated rank and the ground truth likelihoods; and updating one or more parameters of the machine learning model based on the computed loss,” in the claims are recited at a high level, and amount to applying the judicial exception using a generic computer (see e.g. Updated PEG Example 47, claim 2, where the “detecting” and “analyzing” were mental processes, and “using the trained ANN” amounted to generic computer implementation). Mere instructions to apply an exception using a generic computer component cannot provide an inventive concept.
The Examiner disagrees at Pages 13-14 that there is a “concrete technological application in a multi-server prescription adjudication environment” that is a clear technological improvement to the underlying computing and devices that are found in the claims. The Examiner disagrees at Pages 13-14 that the ordered combination of the first and second servers and conditional communication between them comprises significantly more than the abstract idea. As discussed above, the servers are leveraged as generic computer technology to apply the abstract idea using generic computer components and instructions. Mere instructions to apply an exception using a generic computer component cannot provide an inventive concept. Thus, when considering the additional elements alone, and in combination, there is no inventive concept in the claim, and thus the claim is not patent eligible.
For at least these reasons and those stated in the rejection above, the claims are not patent eligible.
Conclusion
The prior art made of record and not relied upon is considered pertinent to applicant's disclosure: U.S. 2021/0134412 A1 to Guaneri et al. at Paras. [0087]-[0090].
Any inquiry concerning this communication or earlier communications from the examiner should be directed to WILLIAM T. MONTICELLO whose telephone number is (313)446-4871. The examiner can normally be reached M-Th; 08:30-18:30 EST.
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/WILLIAM T. MONTICELLO/Examiner, Art Unit 3682
/FONYA M LONG/Supervisory Patent Examiner, Art Unit 3682
