eMDs Version 8.0 Formulary Benefits User Guide

This guide provides instructions for using Formulary Benefits function with the Solution Series modules. With these functions, Solution Series users can:

• Determine the pharmacy benefits and drug copays for a patient’s health plan.
• Check whether a prescribed medication is covered (in formulary) under a patient’s
plan.
• Display therapeutic alternatives with preference rank (if available) within a drug
class for non-formulary medications.
• Determine if a patient’s health plan allows electronic prescribing to Mail Order
pharmacies, and if so, e-prescribe to these pharmacies.
• Download a historic list of all medicationsprescribed for a patient by any provider
(if that medication was submitted for payment as part of any health insurance
plan.)

The Formulary Benefits function allows users to determine the formulary coverage
(i.e.: whether the patient’s insurance plan provides reimbursement for a specific
dispensable medication) prior to prescribing. Other pharmacy-related information,
such as medication copay amounts, the need for prior authorization, quantity limits,
and coverage restrictions by age or gender may also be available.
Further, when a prescribed medication is flagged as not in formulary, the function can
display a list of therapeutic alternative choices that are covered. This allows clinicians
the option to prescribe “in plan” medications (if appropriate) for their patients.