Eligibility and formulary coverage

Providers can now use Treat to check eligibility and real-time group level formulary coverage, eliminating the need to contact the PBM to verify benefits. These insights can also be used for more-informed conversations with patients.

Eligibility

Simply select a payer/PBM from the Eligibility section to assign it to the active prescription order(s).

Real Time Formulary

Real Time Formulary provides payer provided and therapeutic alternatives for the medication selected for prescribers to work with their patients on the best option. This ensures prescribers select a medication that is on formulary and covered by the patients benefits.

PBM/Payer Alternatives

When viewing Real Time Formulary, eligibility information is displayed first in order to help prescribers view the details of the selected medication, its formulary status, and any coverage information.

The coverage table informs the prescriber of any copay or medication specific details by pharmacy type. Any Pharmacy refers to benefit coverage across any pharmacy type, such as retail, mail order, long term care, and specialty. If coverage is specific to pharmacy type, a column will be displayed for each type with its corresponding copay information.

Clicking or hovering over any of the teal content will provide a description or additional information regarding that point of reference. 

The alternatives medication table provides pharmacy type coverage, medication or product type (Generic vs Brand Name), and a formulary status sorted by order of preference.

If an alternate medication is selected, it is now active as part of the order for prescriber to complete the prescribing form or sig and add it to the encounter.

Additional coverage or copay information may be available. Clicking or hovering over any of our teal content will provide a description or additional information regarding that point of reference.

Therapeutic Alternatives

When a payer does not provide medication alternatives, Treat offers therapeutic alternatives that a prescriber may select sorted by its formulary status.