Asepha’s formulary agent monitors payer, PBM, Medicaid, and CMS updates in real time and maps them to your active patients. It flags step therapy, PA, and quantity limits before claims deny, and shows the exact rule behind each change. Teams get in-workflow guidance and covered alternatives so care stays on track and revenue is protected.
Tracks and versions every policy update from PBMs, payers, Medicaid, and CMS. Each change is mapped to your active prescriptions and stored in a searchable library indexed by BIN, PCN, Group, and payer so teams can instantly locate the exact rule or clause behind any change.
Transforms policy updates into clear, patient specific guidance. Teams know which therapies are affected, why they matter, and what to do before denials occur, keeping care on track and revenue protected.
Surfaces the right information at the right time to support daily review and verification tasks. Guidance can appear alongside prescription queues, document queues after IDP, or other review panels depending on configuration.
Prevents margin loss by identifying policy misalignment before claims are submitted. Teams see risks early and act before patients arrive at the pharmacy or infusion center, avoiding write-offs and lost revenue.
