Prescription Formulary FAQ's

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.  
 

FAQs

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.

e-Prescribing

  1. How do I sign up for eRx (e-Prescribing)?
  2. How do I send an eRx (e-Prescription)?
  3. How do I process eRx (e-Prescribing) refill requests?
  4. How do I prescribe multiple medications in a single order?
  5. How do I search for a pharmacy or enter a preferred pharmacy?
  6. Why am I unable to send an eRx (e-Prescription)?
  7. What do eRx (e-Prescribing) error messages mean?
  8. Activating e-prescribing of controlled substances (EPCS): Step 1 of 2
  9. Setting up EPCS e-signing permissions: Step 2 of 2
  10. How do I send e-prescriptions (eRx) and approve refills for controlled substances?
  11. How do I enable and use prescription task delegation?
  12. How do I print and format prescriptions?
  13. What is the status of my eRx (e-Prescribing) request?
  14. Prescription Formulary FAQ's
  15. How do I edit my Drug-Drug and Drug-Allergy Interactions Settings?
  16. How do I add my NPI and DEA numbers to printed prescriptions?
  17. Can I be enabled for e-prescribing on two Practice Fusion accounts at the same time?
  18. How do I edit a refill sent by the pharmacy?
  19. Can I e-Prescribe through multiple eRx vendors?
  20. How do I add a pharmacy to the database?
  21. How can I discontinue a medication?
  22. How can you see the status of an eRx (e-Prescription)?
  23. How does I-STOP affect my practice and what is Practice Fusion doing to prepare for EPCS?
  24. How do I sign up for eRx or EPCS if I have a credit freeze?
  25. What does the eRx (e-Prescribing) "Pending" status mean?
  26. How do I disable my e-prescribing with Practice Fusion?
  27. How do I re-activate eRx (e-Prescribing)?
  28. How can I help a provider verify eRx (e-Prescribing) credentials?
  29. How can I disable refill requests?
  30. How do I update my phone or fax number for eRx (e-Prescribing)?
  31. Who can send an e-prescription?
  32. Why am I not receiving eRx (e-Prescribing) refills?
  33. What if I fail e-Prescribing (eRx) verification?
  34. How do I use eCoupons?
  35. How do I use electronic prior authorizations?
  36. How do I print an e-Prescription receipt?
  37. How do I update the VIP Access application for EPCS?
  38. How do I use medication adherence?
  39. Why am I receiving an alert to update my medical license?
  40. How can I see medication costs and cost-saving alternatives?
  41. What does it mean when a patient medication is no longer available?
  42. Ohio Prescription Instructions
  43. How does the Maine EPCS Opiates Mandate under L.D. 1646 affect my practice?
  44. How do I initiate a request for a prior authorization from the EHR?
  45. How do I submit prior authorizations via Physicians’ Desk Reference (PDR)?

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