Integrate with a PBM's formulary and benefit API to retrieve drug tier, coverage restrictions, and step therapy requirements at the point of prescribing

Steps

1. Access formulary and benefit data through the Surescripts Formulary and Benefit service or a direct PBM API integration; authenticate using OAuth 2.0 client credentials flow with YOUR_CLIENT_ID and YOUR_CLIENT_SECRET
2. Send a formulary query with patient identifier (member ID or demographics), drug identifier (NDC or RxNorm), and prescriber NPI; receive back FormularyStatus (Covered/NotCovered/NonFormulary), TierNumber, CopayAmount, and CoverageRestrictions array
3. Parse CoverageRestrictions for codes indicating Prior Authorization Required, Step Therapy Required, Quantity Limit, Age Limit, or Gender Edit; surface these alerts to the prescriber in the order entry workflow
4. Retrieve step therapy alternative drugs from the response AlternativeMedications list; display alternatives with their tier and estimated patient cost to support shared decision-making
5. For non-formulary drugs, query formulary exceptions workflow if the PBM supports it; otherwise route to the ePA pathway via NCPDP SCRIPT 2017071
6. Refresh formulary data at least annually at plan year start (January 1 for most commercial plans) and after any mid-year formulary updates communicated by the PBM