Most insurers immediately adopted instantaneous confirmation of eligibility, price and appropriateness by online systems when technology provided the capabilities in early 1980s. These primitive online systems of that era enabled better service and dramatically more inexpensive administrative solutions to the drug benefit programs.

The TeleCLAIM system tackles the problem from many aspects of control and optimum dispensing guidelines. Some of the major advantages and capabilities are as follows:

• Intercepts at the Point of Sale for expired insurance eligibility,

• Preventing early refills before the predecessor Rx is finished,

• Preventing duplication of Rx fulfillment at multiple drug stores,

• Variations of Co-Pay price burden for expensive vs. cheaper Brands and Generics,

• Influencing the use of Generics by providing financial incentive to the buyer,

• Controlling price fluctuation by adopting published AWP pricing as a standard for provider contracts,

• Enabling targeted Benefit Plans by providing global or specific drug exclusions,

• Preventing drug interactions and complications resulting from multiple drug use,

• Providing "choice" of equivalent drugs at the Point of Sale for best price options,

• Online (instantaneous) determination of Deductible and Maximum limits,

• Intercepts for a variety of fraudulent schemes (e.g. Female medication to Male),

• Automatic referral to cheaper Mail Order orders for Maintenance drug conditions,

All of the above control considerations result in substantial reductions in Drug Benefit cost. System reports provide guides to utilization by data measurements like "PMPM". This statistic, Cost per Month per Person, is a most compelling barometer of utilization cost.

With this information premium rates can be more accurately established or methods of designing Capitation Benefit programs can be better devised with some sense of reliability for outcome predictions.

Analysis reporting by the TeleCLAIM system enables evaluation of utilization by Age and Gender. This analysis enables more refined prediction of costs based on group statistics needed for a fair Drug Benefit plan.