Formulary Overview

about formulary formulary provides a standard means for pharmacy benefit payers (including health plans and pharmacy benefit managers (pbms)) to communicate formulary and benefit information to prescribers via provider vendor systems pbm/payers use the drug formulary to promote affordable, high quality prescriptions for patients and periodically publish revisions to their drug formularies to represent the current clinical judgment of the pbm/payer and its affiliated providers the service enables provider vendors to receive a range of formulary and benefit information through the service formulary status, preferred alternatives, benefit coverage, and copay information note a drug formulary is a list of prescription drugs, each one assigned a formulary status, which is a rating of that drug’s effectiveness and value about this guide this surescripts formulary companion guide was created to assist pharmacy benefit managers (pbms)/payers in developing and transferring pbm/payer benefit coverage, and group specific formulary information files this guide also aids provider vendors regarding how to use this formulary information notes the terms "pbm/payer" or "processor", who acts on behalf of the pbm/payer or health plan, are referred to as pbm/payer throughout this guide the terms "file" and "transmission" may be used interchangeably throughout this guide the terms "list" or “file” and "transaction" may be used interchangeably throughout this guide as well version terminology change the term “list” is now referred to as “file” (e g , alternatives list is now alternatives file) the audience for this document includes any customer responsible for providing and accessing formulary files document references note this guide is meant to support, integrate, and further clarify the ncpdp standard, implementation guides and best practices as used through the surescripts network it does not reproduce the base standard in its entirety requirements beyond those in the ncpdp documentation are called out in this guide and are also enforceable customers should read and comprehend the associated standards prior to reading this guide please reference the following documents when reading this guide surescripts provided materials connectivity and authentication implementation guide eligibility companion guide formulary file download api overview formulary ids and eligibility fields overview external materials to be obtained by the customer (available at www ncpdp org http //www ncpdp org ) ncpdp formulary and benefit standard implementation guide (v60 republished may 2024) ncpdp formulary and benefit implementation recommendations document ncpdp external code list (version 202404) v60 formulary and benefit standard examples guide version 10 ncpdp formulary and benefit standard version 60 transition guidance version 10 ncpdp script this guide utilizes the ncpdp (national council for prescription drug programs) messaging standard prescriber/pharmacist interface script version 2023011 as a baseline to become an ncpdp member, please go to https //www ncpdp org/membership aspx https //www ncpdp org/membership aspx the ncpdp script standard 2023011 package contains a complete list of fields and additional requirements customers should read and comprehend the associated standards prior to reading this guide ncpdp is an american national standards institute (ansi) accredited standard development organization the ncpdp “script” standard is a copyrighted document and may be obtained by contacting ncpdp 9240 e raintree drive scottsdale, az 85260 7518 phone (480) 477 1000 fax (480) 767 1042 https //www ncpdp org https //www ncpdp org