Insurance Formularies
A formulary defines which products are covered by insurance, which insurers participate, and for how long. Products outside a valid active formulary are considered unqualified and billed entirely to the patient.
Access
- In the left sidebar, click Finance Zone.
- Click Formularies.
You will see a list of active formularies. Each formulary has a validity period. Products are only covered within that date range.
Create a formulary
Click + New Formulary (top right corner) and fill in the form:
| Field | Description |
|---|---|
| Branch / Location | Your business location, if operating across multiple branches |
| Formulary Name | A descriptive name (e.g. RSSB Q1 2025 / RAMQ Trim 2 2026) |
| Valid From | Start date of coverage |
| Valid Until | End date of coverage |
| Participating Insurers | Select one or more insurers who cover products in this formulary |
Click Save to create the formulary.
Changing formulary validity dates after products have been added does not update the coverage dates of already-added products. They inherit the dates at the time they were added.
Always set the correct Valid From and Valid Until before adding the first product.
Multiple insurers, different coverage rates
A single formulary can have multiple participating insurers, each with their own coverage percentage.
Example:
For the same product on a formulary with 3 participating insurer:
| Insurer | Coverage | Patient pays |
|---|---|---|
| Insurance A | 75% | 25% |
| Insurance B | 50% | 50% |
| Insurance C | 90% | 10% |
All three insurers cover the same products (e.g. Nurofen, Paracetamol). The patient's share depends on which insurance card they present.
→ See Insurance Partners to configure individual coverage percentages per insurer.
Add products to a formulary
- From the formulary list, click on the formulary name to open it.
- In the Search Medicine field, find the product.
- Click Add to Coverage List.
The product is automatically added under all participating insurers of this formulary.
Remove products from a formulary
- Click on the formulary name to open it.
- In the Find Product field (on the right), search for the product.
- Click the remove icon.
The product is automatically removed from all participating insurers of this formulary.
When products become unqualified
A product loses insurance coverage in any of these cases:
| Condition | Effect |
|---|---|
| Today's date is outside Valid From / Valid Until | Product unqualified |
| Formulary is inactive (even if dates are valid) | Product unqualified |
| Product removed from formulary | Product unqualified |
Edit a formulary
From the formulary list, click the Edit button on the formulary row and update the fields as needed.
Editing the validity dates does not retroactively update products already added. Only products added after the date change will inherit the new dates.
Key points
| Point | Detail |
|---|---|
| Validity period | Products only covered within the date range |
| Inactive formulary | Disqualifies all included products regardless of dates |
| Multiple insurers | One formulary can serve several insurers at different rates |
| Adding products | Applied to all participating insurers automatically |
| Removing products | Removed from all participating insurers automatically |
| Date changes | Do not affect already-added products. So set dates first |