General Requirements Best Practices

formulary full loads, updates, and deletions surescripts expects pbm/payers to be able to do formulary full loads, updates, and file deletions a full load must be all formulary information for the pbm/payer (every file of any type for all plans) a full load will not retain any prior information a full load should be sent on a limited frequency, quarterly is best, no more than once per month updates are independent of full loads and should happen more often than full loads sending only updates is acceptable (without a full load), but a pbm must also send appropriate deletes deleting formulary file when should a pbm delete a formulary file? formulary files should be deleted when a plan is retired or transferred to another pbm removing files that no longer return matches in eligibility responses helps surescripts maintain current data and prevents ehrs from downloading unnecessary information for legacy files, such as those that existed in v3 0 and continue in v60, pbms should use the same file ids for lists that were previously grouped together for example, these three files will each use the same file id individually the prior authorization(pa) file id, quantity limit(ql) file id, and age limit(al) file id using the same file ids across list types allows surescripts to down translate formulary data from v60 into v3 0 note pbms should update each file at least once every 13 months if not updated, surescripts reserves the right to remove this data coverage element modeling best practice if a coverage element has a minimum but no maximum, omit the maximum field do not use 0 or other placeholders