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Surescripts
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
2.14 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.
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.
Bring coverage details into prescribing
Automatically verify and show group-level formulary information within the prescribing workflow.
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.
Indicate benefit coverage restrictions
Flag when a patient’s health plan requires prior authorization or step therapy for a medication.
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.
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.
Reduce costs and improve compliance
Give prescribers and pharmacists immediate insight into the most preferred and cost-effective medication options based on the formulary.
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.
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.
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.
Bring coverage details into prescribing
Automatically check and show group-level formulary information within the prescribing workflow.
Get formulary tier information
Help providers understand which medications have the best coverage and lowest cost with tier information from the benefit plan.
See benefit coverage restrictions
Understand if a patient’s health plan requires prior authorization or step therapy for a medication.
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.
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.
Encourage use of on-formulary medications
Show a drug’s formulary status, tier and mail-order availability based on the patient’s benefit plan.
Reduce costs and improve compliance
Give prescribers and pharmacists immediate insight into the most preferred and cost-effective medication options based on the formulary.
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.
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.
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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.
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Get the prescriber perspective
See how your formulary information will appear to prescribers within an EHR using the Formulary prescriber view tool.
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Success Stories
Real-world results
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
- CAQH, "Working Together: Advances in Automation During Unprecedented Times," 2022, p. 44.
- Surescripts, “2023 National Progress Report,” March 2024.
- 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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