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Ineffective formulary validations restrict patient access to medications and cost manufacturers millions of dollars.

  • Formularies change frequently, which means rebates may be paid based on outdated information.
  • Formulary data is frequently incomplete, outdated, or inaccurate and requires standardizing prior to processing.
  • Relying on manual processes to handle and reconcile massive Rx volumes with thousands of complex payer and pharmacy benefit manager (PBM) contracts creates delays and mistakes that lead to overpayments.

How Model N Formulary Compliance helps you

This integrated data validation and formulary auditing solution enables you to overcome the challenges of ensuring formulary compliance.

Maximize market access

Formulary validations ensure your drugs receive the prioritized positioning outlined in payer and PBM contracts.

Reduce revenue leakage

Thorough audits of all products across plans within payment cycles reduces overpayments.

Streamline operations

Real-time formulary data is accessible throughout the year for more accurate, efficient, and comprehensive validations.

Improve customer satisfaction

Automated validations ensure precise, timely rebates and reduce the need for post-payment recovery.


Annual audits in individual companies have uncovered $25 to $75 million in overpayments due to non-compliant formularies

Ensure formulary compliance with a full-service automated data and formulary auditing solution

Model N Formulary Compliance eliminates the need for internal manual validations or third-party audits.

Integrated efficient data

Access collected and consistently stewarded formulary data that covers most commercial and government plan formularies across all therapeutic areas.

Rx-level formulary compliance

Compare contractual terms and conditions that drive rebates with published formulary data to determine formulary compliance at the plan or prescription level.

Reporting and visibility

Gain insight into formulary compliance outcomes and trends to support account management and future contract negotiations.

Evaluate formulary compliance during rebate processing

Doctor using computer Document Management System (DMS), online documentation database process automation to efficiently manage files

Model N Formulary Compliance integrates with Model N Validata and Model N Payer Management to provide an end-to-end solution for managing payer contracts. Along with streamlining processes, this robust solution improves calculation accuracy and prevents overpayments from occurring.

  • End revenue leakage in payer contracting and rebating processes.
  • Ensure contract and formulary compliance.
  • Increase patient access to your life-changing products.
  • Strengthen relationships with payers and PBMs.
Doctor using computer Document Management System (DMS), online documentation database process automation to efficiently manage files

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