Formulary Agent provides real-time policy-intelligence that tracks payer and plan changes and maps them to your active prescriptions. The agent watches for policy updates and flags any patient that will be impacted, surfacing what changed, why it matters, when it takes effect, and the next best action.
Tracks and versions every policy update from PBMs, payers, Medicaid, and CMS. Each change is mapped to your active prescriptions and stored in a searchable library indexed by BIN, PCN, Group, and payer so teams can instantly locate the exact rule or clause behind any change.
Transforms policy updates into clear, patient specific guidance. Teams know which therapies are affected, why they matter, and what to do before denials occur, keeping care on track and revenue protected.
Surfaces the right information at the right time to support daily review and verification tasks. Guidance can appear alongside prescription queues, document queues after IDP, or other review panels depending on configuration.
Prevents margin loss by identifying policy misalignment before claims are submitted. Teams see risks early and act before patients arrive at the pharmacy or infusion center, avoiding write-offs and lost revenue.
