Overview

Guide treatment plans with formulary details

With formulary information at their fingertips, prescribers can optimize medication choices for coverage and affordability without needing to call pharmacy benefit managers (PBMs) or health plans. Plan-level formulary details support more-informed conversations for a better patient experience.

$15.09

potential savings per transaction when accessing benefit information electronically1

2.03 million

healthcare professionals and provider organizations connected2

20%

increase to first-fill medication adherence with use of electronic prescribing, eligibility and formulary information3

A closer look

What can Formulary do for you?

Choose your organization type to see how Formulary can help identify safe, appropriate medication that patients can afford and take consistently.

  • EHR vendors
  • Health plans
  • Health systems
  • PBMs

Increase prescribing efficiency and patient satisfaction

Add clear information about patient formulary coverage to the prescribing workflow to help providers assess which medications will be most affordable and effective for patients. Use this information to kickstart Real-Time Prescription Benefit and Electronic Prior Authorization.

icon coverage details prescribing
Bring coverage details into prescribing

Automatically verify and show group-level formulary information within the prescribing workflow. 

icon display formulary information
Display formulary tier information

Help providers understand which medications have the best coverage and lowest cost to the patient with tier information from the benefit plan.

icon beneit coverage resistrictions
Indicate benefit coverage restrictions

Flag when a patient’s health plan requires prior authorization or step therapy for a medication.

icon fully integrated workflow
Fully integrated with your workflow

Give prescribers access to formulary coverage information in the moment of care.

How it works for EHR vendors

Your EHR downloads the most recent Formulary files on a defined cadence.

Surescripts provides a comprehensive Formulary file with information supplied directly by PBMs and health plans.

During prescribing, providers access Formulary information within your medication module.

Prescribers can review drug tiering, prior authorization flagging, and specialty drug and step therapy requirements.

Having made an informed decision, the prescriber sends the e-prescription to the pharmacy.

Formulary is fully integrated into the e-prescribing workflow, so it’s simple to complete the e-prescription.

EHRVendors HealthSystems@2x 3

Guide medication selection for your members

Deliver plan-level information to prescriber workflows to provide insight into the most preferred and cost-effective medication options from the start. Use this information to kickstart Real-Time Prescription Benefit and Electronic Prior Authorization.

icon reduce costs
Reduce costs and improve compliance

Give prescribers and pharmacists immediate insight into the most preferred and cost-effective medication options based on the formulary.

icon enourage onformulary medications
Encourage use of on-formulary medications

Show a drug’s formulary status, tier and mail-order availability based on the patient’s benefit plan to help prescribers choose affordable options.

icon convey medication requirements
Convey medication requirements

Provide information on medication requirements such as prior authorizations or step therapy.

How it works for health plans

Send your formulary files to Surescripts directly or through your PBM.

Use up-to-date formulary data to inform prescribers about medication coverage, tiering and therapy management programs.

Prescribers access Surescripts Formulary through their electronic health record (EHR).

Prescribers can review drug tiering, prior authorization flagging, and specialty drug and step therapy requirements.

The prescriber makes an informed decision so your members get the best care.

The formulary data you supply helps avoid cost or coverage barriers, meaning members get appropriate treatment faster.

HealthPlans PBMs@2x 2

Increase prescribing efficiency and patient satisfaction

Add clear information about patient formulary coverage to the prescribing workflow to help providers assess which medications will be most affordable and effective for patients.

icon coverage details prescribing
Bring coverage details into prescribing

Automatically check and show group-level formulary information within the prescribing workflow. 

icon formulary tier information
Get formulary tier information

Help providers understand which medications have the best coverage and lowest cost with tier information from the benefit plan.

icon benefit coverage restrictions
See benefit coverage restrictions

Understand if a patient’s health plan requires prior authorization or step therapy for a medication.

icon fully integrated workflow
Fully integrated with your workflow

Give prescribers instant access to formulary coverage information while discussing treatment options with their patients.  

How it works for health systems

Your EHR receives Formulary files from Surescripts.

Formulary files include comprehensive information supplied directly by PBMs and health plans.

Prescribers access Formulary information in their e-prescribing workflow.

They can review drug tiering and information on prior authorization, specialty drug and step therapy requirements.

Having made an informed decision, the prescriber sends the e-prescription to the pharmacy.

Formulary is fully integrated into the e-prescribing workflow, so it’s simple to complete the e-prescription.

EHRVendors HealthSystems@2x 3

Guide medication selection for your members

Easily indicate formulary status, tier and mail-order availability. Premium features help fine-tune how your formulary data will appear to clinicians.

icon encourage uses onformulary medications
Encourage use of on-formulary medications

Show a drug’s formulary status, tier and mail-order availability based on the patient’s benefit plan.

icon reduce readmissions
Reduce costs and improve compliance

Give prescribers and pharmacists immediate insight into the most preferred and cost-effective medication options based on the formulary.

icon convey medication requirements
Convey medication requirements

Provide information on medication requirements such as prior authorizations or step therapy.

How it works for PBMs

Send your formulary files to Surescripts.

Use up-to-date formulary data to inform prescribers about medication coverage, tiering and therapy management programs.

Prescribers access Surescripts Formulary through their electronic health record (EHR).

Prescribers can review drug tiering, prior authorization flagging, and specialty drug and step therapy requirements.

The prescriber makes an informed decision so your members get the best care.

The formulary data you supply helps avoid cost or coverage barriers, meaning members get appropriate treatment faster.

HealthPlans PBMs@2x 2
Features In Focus

Optimize your data with Formulary insights

PBMs can access powerful dashboards and additional tools to troubleshoot formulary issues and target coverage factors more efficiently.

Check file uploads

Ensure successful uploads with formulary file check. View formulary files submitted within a chosen timeframe and scan them for errors.

Identify inconsistencies

Use the NDC inspect tool to check consistency across related National Drug Codes (NDCs)—ensuring EHRs display accurate information and helping prescribers assess whether a medication is covered.

Get the prescriber perspective

See how your formulary information will appear to prescribers within an EHR using the Formulary prescriber view tool.

Success Stories

Real-world results

“When we talked to prescribers, 83% said they think about benefit data as they prescribe. It’s essential for medication adherence, and it’s truly available for virtually every patient in the country.”

Andrew Mellin, MD Chief Medical Officer, Surescripts
FAQs

Find out more about Formulary

What does the Formulary file include?
  • Medication formulary status and tiering 
  • Payer-provider alternatives
  • Coverage factors: prior authorization flags, step therapy requirements and days’ supply limitations
     
How can my organization sign up to share or receive data through Surescripts Formulary?

We are always expanding our partnerships for Formulary. 

To get conversations started, click the “Get in touch” button below

Insights

Keep pace with healthcare innovation

Footnotes
  1. CAQH, "Working Together: Advances in Automation During Unprecedented Times," 2022, p. 44.
  2. Surescripts, “2022 National Progress Report,” March 2023.
  3. Jaime Y. Smith et al., “E-Prescribing with Decision Support is Associated with Improvements in Medication Adherence,” The American Journal of Pharmacy Benefits 8, no. 4 (August 17, 2016).
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