E. Price Formulary File
Common Uses
Loyalty discount programs
Senior discount programs
Clinic-specific pricing
Cash prescription discount programs
Custom quantity-based pricing schedules
Fixed pricing for specific medications
The Price Formulary File
The Price Formulary File allows pharmacies to create and manage price formularies that can be assigned to drugs and insurance plans. Price formularies are commonly used to support special pricing programs, such as loyalty discounts, senior discounts, or other custom pricing initiatives.
Price formularies created in this file can be assigned from the Price Formulary tab within the Drug File.
To access the Price Formulary File screen, click on File E. Price Formulary File.
Adding a New Price Formulary
Select Add Price Formulary, enter a name for the formulary, and click Save. Select Save & Exit to save the formulary and return to the Rx Processing screen.
Editing an Existing Price Formulary:
Select Edit Price Formulary, locate the desired formulary from the list or search using all or part of the formulary name, make the necessary changes, and click Save. Select Save & Exit to save the changes and return to the Rx Processing screen.
Deleting a Price Formulary
Select Edit Price Formulary, choose the desired formulary, click Delete, and confirm the deletion when prompted. Use Cancel to clear the current screen without saving changes.
Configuring a Price Formulary in Drug File
Price Formularies can be configured for in-house loyalty programs, senior discounts, or other pricing strategies. This feature is linked to the Price Formulary File and allows formularies to be assigned to specific insurance plans.
To add a Price Formulary, click Add/Edit Price Formulary in the Drug File. A pop-up window will appear where you can select a formulary from the Formulary Name dropdown. Enter the quantity ranges and corresponding retail prices, repeating the process until all desired ranges have been added. When finished, click Save & Exit or press Enter while the button is highlighted.
Note: If no custom formulary is selected, the system defaults to the Basic Cash Formulary, which applies pricing to all cash prescriptions for the drug.
Select the desired formulary from the Formulary Name drop-down, enter the quantity ranges and corresponding retail prices, and continue until all required ranges are defined. Click Save & Exit or press Enter while the button is highlighted to save the entries. To edit a formulary, open the drug in Edit mode, navigate to the Price Formulary screen, click Edit Formulary next to the desired entry, update the quantities and prices, and click Save & Exit or press Enter. To delete a formulary, open it in Edit mode, click Delete (or press Enter), and confirm by selecting Yes when prompted. Selecting Delete All Price Formularies will remove all formularies on file, including default and custom entries such as Basic Cash Formulary, Patients Over 80, or Patients Over 70. To clear all entered quantities and prices, click Cancel or press Enter. To exit the screen, click Exit, or select Back to Main (or press Enter) to return to the Drug Info screen.
Common Issues & Resolutions
Price Formulary Affecting Insurance Pricing or U&C
Issue: A Price Formulary appears to affect insurance pricing or causes the U&C amount to match the cash price unexpectedly.
Resolution: Review the insurance plan's Pricing settings and the pharmacy's U&C calculation settings. If U&C is configured to calculate from cash pricing, the formulary may be used when calculating the U&C value. Consider changing the U&C calculation method if cash pricing should not be used.
Price Formulary Does Not Apply
Issue: The expected formulary pricing does not appear when processing the prescription.
Resolution: Verify the formulary is assigned to the correct drug, review the quantity-based pricing entries, and test using a new prescription after making changes. Also confirm that no other pricing configuration is overriding the formulary.
Price Formulary Cannot Set Cost to Bill or Copay
Issue: The pharmacy wants a formulary to automatically control the Cost to Bill field or force a specific copay amount.
Resolution: Price Formularies adjust the total prescription price but do not directly control the Cost to Bill field. Insurance copays are determined by the insurance claim response and cannot be controlled through a Price Formulary alone.
Drug Price Changes When Changing NDC or Drug
Issue: The prescription price changes when a different drug or NDC is selected.
Resolution: Configure matching formulary pricing for each applicable drug if consistent pricing is required when switching products. If the replacement drug does not have a matching formulary, the system will revert to its normal pricing.
Importing Price Formularies
Issue: The pharmacy wants to import formulary pricing from a spreadsheet or another pharmacy.
Resolution: No import functionality was identified in the referenced support discussions. Price Formularies must be manually created or recreated using an existing setup as a reference.