Importance

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Abstract

Systems, methods, and computer-readable media are provided for determining patient eligibility for one or more types of sponsored healthcare services and providing notifications thereof. An example healthcare service is high-risk medication monitoring. A program sponsor may provide an indication of a high-risk prescription drug in connection with which a patient may be eligible for medication monitoring. The program sponsor may also provide an indication of an alternative prescription drug that may be used for treating the same health condition for which the high-risk drug is used. Upon receipt of a healthcare claim transaction that includes a claims processor identifier associated with program sponsor and a prescription drug identifier that identifies the high-risk drug, a number of one or more prior healthcare claim transactions corresponding to dispensing of the high-risk drug to the same patient may be determined. If the number of prior healthcare claim transactions is determined to be less than a threshold number, an alert message may be generated that includes an indication of the high-risk drug, an indication of the alternative drug, and an indication that the alternative drug is available for prescribing as an alternative to the high-risk drug. The alert message may be transmitted to the healthcare provider computer from which the healthcare claim transaction was received. Subsequent healthcare claim transactions received form the healthcare provider computer may be monitored to determine whether the alternative drug was substituted for the high-risk drug.

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First Claim