What should a formulary management platform actually make easier?
A closer look at the work behind the features, and the questions worth bringing to your next platform evaluation.
Explore the articleFollow a formulary update.
Identify which formularies are affected and compare the proposed update with the current information.
Confirm which version is being reviewed, who needs to contribute, and what quality checks belong in the process.
Explore how approved information reaches the outputs and downstream systems that need it.
Ask what changed, when it changed, and how the team can retrieve the information later.
A formulary update may start with a change to a drug’s coverage status. Getting that change ready for use can involve a much longer conversation.
Which formularies are affected? Is everyone reviewing the same version? What needs to be updated downstream? And when the work is finished, can the team clearly explain what changed?
These are useful questions to bring into a platform evaluation because they get close to the work health plans and pharmacy benefit managers (PBMs) need to manage every day. A feature list can tell you what a platform offers. A real workflow shows whether those capabilities will make your team’s work easier.
That’s where the evaluation should begin: with the steps that require the most checking, coordination, and follow-up.
Keeping track of change
Consider a team preparing a tier change that affects several formularies. Before anyone can move forward, they need to understand where the change applies, compare it with the current information, and confirm which version is ready for review.
If those answers live across spreadsheets, saved files, and email threads, the team has another task before the review even starts: piecing together a reliable picture of the update.
A formulary management platform should make that picture easier to see. Teams should be able to work from organized formulary information, compare changes, and understand which records they are reviewing. That becomes especially useful when an organization manages multiple benefit designs or client requirements.
During a demo, bring a change your team would actually make and ask the vendor to walk through it. How do you identify the affected formularies? How do you compare the proposed update with the existing information? What can a reviewer see without opening another file?
Pay attention to how much work still happens outside the platform. That is often where the day-to-day effort becomes clearer.
Make the difference visible.
What should the reviewer be able to see?
Where the update applies, what differs from the current information, and which version is ready for review.
Moving information where it needs to go
An approved formulary update still has somewhere to go. Depending on the organization’s setup, that information may be needed in claims adjudication, e-prescribing, prior authorization, or member-facing channels.
The practical question is how the information gets there, and what your team has to do along the way.
When evaluating a platform, ask which connections are available for your specific systems and how updates move through them. Get clear on what is included, what needs configuration or custom work, and how timing is handled. An integration capability is useful when it fits the workflow your organization actually uses.
It is also worth asking what happens when something does not go as expected. Who can see that an update needs attention? How is it corrected? How does the team confirm the receiving system has the information it needs?
Those questions help turn an integration discussion into something your operations team can assess.
Where does the update go next?
Ask how approved information reaches the receiving system, and how your team confirms the update.
Ask which connections are available for your networks, what configuration is required, and how timing is handled.
Explore how formulary information reaches PA workflows and what happens when an update needs attention.
Follow how information reaches member-facing outputs, including the review needed before release.
Getting from approval to publication
Approving a change and preparing it for publication are different steps. The information may need to appear in a formulary guide, on a website, in a required file, or in communications for the people affected.
A useful platform should reduce the repeated work involved in producing those outputs while keeping review and quality control part of the process.
Ask to see how an approved change becomes a published output. Does the team need to re-enter information? Which formats can be produced? How are differences between formularies or audiences handled? What review takes place before the output is released?
This is also a good place to discuss the submission and publishing requirements that apply to your organization. Ask the vendor to show how the platform supports those requirements and where your team’s responsibilities remain.
The goal is a process people can follow and verify, with fewer opportunities for an update to get lost between approval and publication.
One update. Different destinations.
Formulary guides
Which formats can be produced, and does your team need to re-enter approved information?
Website publishing
What checks happen before information is released to a member-facing digital channel?
Required files
How are the file and submission requirements that apply to your organization supported?
Communications
How are differences between formularies and audiences handled before communications are released?
Making the record easier to follow
Weeks after an update goes live, someone may ask what changed and when. The team should be able to answer without reconstructing the entire project from memory.
Change history and reporting deserve attention during evaluation because they support the work that continues after implementation. Teams may need to review a file change, investigate a configuration update, or gather records for an internal review.
Ask what the platform records and how that information can be retrieved. Can you compare versions? What details are included in a change report? Are review and approval records available, and what do they show?
Do not assume that an activity log provides everything your team needs. Have the vendor demonstrate a specific question your organization might need to answer. The usefulness of the record becomes much easier to judge when you see how someone would use it.
Useful now. Retrievable later.
The proposed change
Can you retrieve the earlier information and compare it with the update?
The review and approval
Are review and approval records available, and what do they show?
The implementation
Which file and configuration changes are recorded, and how can they be investigated?
The later question
Can someone answer what changed and when without reconstructing the work from memory?
Evaluating the work behind the features
A strong demo should leave your team with a clear understanding of the process they would use. Choose one realistic formulary change and follow it through review, downstream updates, publishing, and reporting.
Along the way, notice where someone has to re-enter data, switch tools, check a separate file, or contact another person for an answer. Some of those steps may be appropriate for your organization. Others may be exactly the work you are hoping to simplify.
That distinction helps you evaluate the platform against your priorities. It also creates a more useful conversation about implementation, configuration, and the responsibilities each team will retain.
Follow one realistic change.
A closer look at FormularyHub
Agadia’s FormularyHub brings pharmacy and medical benefit formulary management into a centralized, web-based solution. Its capabilities include creating and maintaining formularies, comparing changes, automated formulary publishing, change reporting, and workflow-based quality control.
FormularyHub also supports integrations with adjudication systems, e-prescribing networks, EMR systems, and prior authorization software. It supports CMS submission and state publishing needs through structured workflows and reporting.
For health plans and PBMs exploring a new approach, the next step is to see how those capabilities fit their own systems and processes. Bring the formulary change that takes your team the most coordination, and use it to start the conversation.
Explore FormularyHub and request a demo with Agadia to see how it could support your formulary operations.
