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 Final Office Action is in response to the Amendment and Remarks filed 12/05/2025. Claims 1, 3, 6, 13 and 19-20 are amended. Claim 2 is cancelled. Claims 1 and 3-20 are pending and considered herein.
Claim Rejections - 35 USC § 112
The following is a quotation of 35 U.S.C. 112(b):
(b) CONCLUSION.—The specification shall conclude with one or more claims particularly pointing out and distinctly claiming the subject matter which the inventor or a joint inventor regards as the invention.
The following is a quotation of 35 U.S.C. 112 (pre-AIA ), second paragraph:
The specification shall conclude with one or more claims particularly pointing out and distinctly claiming the subject matter which the applicant regards as his invention.
Claims 1-5, 8-12 and 16-18 are rejected under 35 U.S.C. 112(b) or 35 U.S.C. 112 (pre-AIA ), second paragraph, as being indefinite for failing to particularly point out and distinctly claim the subject matter which the inventor or a joint inventor (or for applications subject to pre-AIA 35 U.S.C. 112, the applicant), regards as the invention.
Regarding claim 1, “the second server” is recited before “a second server” and lacks antecedent basis. Appropriate correction is required.
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 the second server of the second claim adjudication entity; 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 a second server 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.
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,” and first and second server, and neural network and machine learning models, which are recited at a high level of generality. 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 the second claim adjudication entity; 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 transmitted, and the generic “computerized method,” computer processor and memory and non-transitory computer-readable instructions and 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.
The claims can also be classified as an abstract idea including mental processes. That is, other than reciting a generic “computerized method” and servers where data are transmitted, and the generic computer processor and memory and non-transitory computer-readable instructions, and machine learning/neural networks, nothing in the claim elements precludes the steps from practically being performed in the mind. For example, but for the generic computer devices and machine learning models, receiving information related to a patient prescription claim and determining an adjudication fulfillment based on the data, in the context of this claim, encompasses one skilled in the pertinent art to manually determine the details of the data for analysis and adjudication fulfillment to the optimal or selected candidate. If a claim limitation, under its broadest reasonable interpretation, covers performance of the limitation in the mind but for the recitation of generic computer components, then it falls within the “Mental Processes” grouping of abstract ideas. Accordingly, the claim recites an abstract idea.
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, and the generic computer processor and memory and non-transitory computer-readable instructions for the sending and receiving and calculation of information 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, and the generic computer processor and memory and non-transitory computer-readable instructions 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 presents on a client device certain claim adjudication entities, which are 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 causing presentation on the client device as claimed does not integrate the abstract idea into a practical application and does not amount to significantly more than the abstract idea itself. Claim 4, transmits communications about claim adjudication entities to servers and further limits the abstract idea. Claim 5 describes a ranking model 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, 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 machine learning and a neural network which are 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 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 8 further details features and further limits the abstract idea. Claim 9 describes times and timed data and limits the abstract idea. Claims 10-12 detail initial or alternate fulfillment information and responses and limits the abstract idea. Claims 14-15 details a drug profile and limits the abstract idea. Claim 16 includes 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 describes the drug profile and limits the abstract idea. Claim 18 details fulfillment information and limits the abstract idea. Therefore, the claims are not patent eligible.
Response to Arguments
Applicant’s remarks filed December 5, 2025 have been fully considered, but they are not entirely persuasive. The following explains why:
Applicant’s arguments pertaining to prior art rejections are persuasive. The amended claims overcome the 35 U.S.C. §103 rejection. Claim 2 is cancelled and incorporated in claim 1, and as indicated in the Nonfinal Office Action at Page 19, the prior art does not teach or describe “wherein the determining that the one or more features correspond to the one or more criteria comprises: receiving input from the patient for opting into an alternate claim adjudication process comprising communication with the second server of the second claim adjudication entity.” Claims 6 and 13 are now independent claims and include the previously indicated as allowable recitations “wherein the model comprises a machine learning model comprising a neural network, the machine learning model trained to establish a relationship between a plurality of prescription drug features and likelihoods indicating that a set of alternate fulfillment information of the second server outranks a set of fulfillment information of the first server,” and “comparing the initial fulfillment information with the alternate fulfillment information; determining that the alternate fulfillment information is associated with a higher priority than the initial fulfillment information in response to comparing the initial fulfillment information with the alternate fulfillment information; and in response to determining that the alternate fulfillment information is associated with the higher priority, selecting, as the claim adjudication process, operations for adjudicating the claim for the prescription drug via the second claim adjudication entity.” The references previously cited in the Nonfinal Office Action, as well as U.S. 2020/0043035 A1 to Peysekhman et al., U.S. 2021/0374876 A1 to Cedergreen at Paras. [0024]-[0031] (multiple entities and claim adjudication), [0069]-[0072] (prescription drug fulfillment and alternate information compared in hierarchy for selection), are pertinent prior art.
Thus, the amended claims overcome the rejection under 35 U.S.C. §103.
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 2019 Revised Patent Subject Matter Eligibility Guidance (2019 PEG) and Updated PEG. The arguments at pages 9-10 of Applicant’s Remarks are not persuasive. At pages 9-10, 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 and mental processes, discussed above. The December 2025 Memo is considered and the basis for the rejection under 35 U.S.C. §101 is still operative. The activity of comparing claim adjudication processes and making a 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.
Therefore, the claims are not patent eligible.
Conclusion
THIS ACTION IS MADE FINAL. 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.
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