Note: Access to the EHR features described in this article may differ for practices who have already purchased a Practice Fusion EHR subscription plan. Please contact Practice Fusion Customer Service for additional information.
Your e-prescribing workflow automatically displays patient’s health plan formulary information to help you determine the most clinically appropriate and cost effective medication while preventing needless callbacks from the patient or pharmacy.
Each time you send an electronic prescription, you will be presented with a formulary details screen. You can quickly review the formulary status of the selected medication based upon your patient’s insurance plans and Pharmacy Benefits Managers (PBMs).You may substitute the original prescription with a preferred alternative medication by clicking Replace to the right of the medication.
If a patient has multiple insurance plans, you can adjust the the Pharmacy Benefit Manager (PBM) selection on the Formulary Details screen to review additional alternative medications.
What is drug formulary?
Every insurance payer maintains a formulary database in which different medications are assigned a tier at which they will be paid by the specific insurance policy. The formulary functionality in Practice Fusion gives the status for all medications prescribed, as long as eligibility information for that patient is available. Prescribers are presented a full list of alternative medications.
How do I activate formulary?
You must be enabled for e-Prescribing in order to activate and utilize formulary.
How is patient formulary determined?
Practice Fusion uses information from both the patient’s insurance as well as the Pharmacy Benefits Manager database to ensure formulary information is up-to-date and accurate. If a specific patient’s formulary information is unavailable, providers will receive the notification "Unknown - No active or valid coverage”.
Where will I see the drug formulary? Can I disable it?
Each time you send an electronic prescription, you will be presented with a formulary details screen. Drug formulary checks are required for all electronic prescriptions and cannot be disabled to ensure providers and patients make informed decisions based on insurance and treatment options.
Why do I see the drug formulary screen every time I send an e-Prescription?
Drug formulary checks are required for all electronic prescriptions and cannot be disabled to ensure providers and patients make informed decisions based on insurance and treatment options.
What is “on formulary”?
“On formulary” means the medication is covered by the patient’s prescription plan. Even if a medication is “on formulary”, Practice Fusion will automatically check for alternative medications that may be more preferred by the patient’s plan.
What is“off formulary”? What if a medication is “off formulary”?
“Off formulary” means the medication is not covered by the patient’s prescription plan. If a medication is off formulary, it can still be prescribed; a pharmacist may contact the practitioner to approve a generic or therapeutic alternative.
What do the Preference Levels indicate?
Formulary status is defined by using a simple, low-to-high scale from level 1-99. Drugs with a lower formulary status are considered less preferable by the payer; those with a higher status are more preferable. The higher the number, the more the insurance company prefers that choice and will be likely to reimburse. Please reference the formulary status definitions below:
- 1 = Non-Formulary
- 2 = On Formulary/Non-Preferred
- 3-99 = On Formulary/Preferred
What if a patient's medication formulary information is not found?
If a patient's formulary information is not found, there will not be medication formulary alternatives available. Providers will be able to continue the prescription workflow if no alternatives are returned.
What if the patient has multiple plans?
You can select the plan that is listed by changing the Pharmacy Benefit Manager (PBM) selection on the Formulary Details screen.