Express Scripts Strategic Development, Inc.

Jacob Jon Cedergreen

Katherine Harini Sundararaman

Christopher Ray Fowler

Methods and systems for maintaining pharmacy provider networks are described. In one embodiment, claims adjudication data associated with a member and a prescribed drug is accessed. The prescribed drug associated with the member is classified as one of an acute medication and a maintenance medication. A pharmacy provider network is associated with the prescribed drug based on, at least in part, classifying the prescribed drug. It is determined if a pharmacy associated with the claims adjudication data is included within the pharmacy provider network associated with the prescribed drug. A pharmacy claim may be adjudicated for the prescribed drug based on the claim and the pharmacy provider network. Additional methods and systems are disclosed.

Methods and systems for maintaining pharmacy provider networks

Methods and systems for managing pricing guarantees for prescription drugs are described. In one embodiment, a designation of a pharmacy within a pharmacy network may be received as a preferred pharmacy designation. The preferred pharmacy designation may be associated with a member. A set of preferred pharmacy benefits may be associated with the member and the preferred pharmacy designation. A pharmacy claim associated with the preferred pharmacy designation for a prescription for the member may be adjudicated based on the set of preferred pharmacy benefits. Other methods and systems are described.

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Saint Louis, MO, United States of America

Jacob Jon Cedergreen