FormularyHub, an RxContinuum Solution™ by Agadia, is a fully customizable, web-based platform designed to simplify the complex and time-consuming tasks of formulary benefit design (FBD) management for Health Plans, Pharmacy Benefit Managers (PBMs), and Third-Party Administrators (TPAs). The solution provides a centralized, automated system to control the entire lifecycle of formulary management, from creation and implementation to maintenance and publishing, covering both pharmacy and medical benefit formularies.
Key Features and Capabilities
- Automated Formulary Building: Streamlines the creation of custom and standard formularies by integrating data from multiple sources, identifying preferred alternatives, and managing exclusion lists.
- Real-Time Integration: Provides real-time integration with Point of Adjudication systems at the PBM, e-prescribing networks, and EMR (Electronic Medical Record) systems to deliver critical formulary information to prescribers and other stakeholders instantly.
- Regulatory Compliance: Ensures compliance with state and CMS (Centers for Medicare & Medicaid Services) regulations for file submission and website publishing, leveraging a built-in workflow engine for quality control measures.
- Seamless Updating and Publishing: Automatically tracks changes to drug availability, pricing, and treatment guidelines, and efficiently publishes these updates to all relevant parties in real-time.
- Robust Reporting: Tracks all formulary file changes and configuration updates, providing comprehensive insights for audits, performance tracking, and generating member-centric communications.
- Formulary Module Management: Allows easy management of formulary modules such as preferred alternatives, exclusion lists, financial parameters, POS coverage edits, and administration types (open, incentive, closed).
Target Users and Use Cases
FormularyHub is primarily targeted at Health Plans, Pharmacy Benefit Managers (PBMs), and Third-Party Administrators (TPAs). Its core use cases are:
- Formulary Creation and Maintenance: Building, configuring, and managing custom and standard formulary files across all lines of business (Commercial, Medicare, Medicaid).
- Regulatory Compliance: Ensuring continuous adherence to evolving state and CMS guidelines, including the production and submission of compliant formulary guides.
- Point-of-Care Communication: Delivering real-time formulary information to prescribers via EMR and e-prescribing networks to support timely, informed decision-making and drive utilization of preferred alternatives.
- Operational Efficiency: Automating manual processes to reduce administrative overhead, improve operational efficiency, and optimize costs.