Methodology

How Our Data Works

Transparency about where our data comes from, how it is verified, and what happens when you run a search.

One Source: The Official State PDL

FormCheckRx formulary data comes from one source: the official Preferred Drug List published by each state's Medicaid authority. We do not use third-party data aggregators, commercial drug databases, or crowdsourced information.

For each verified state, a licensed PharmD reviews the official PDL and enters formulary status, prior authorization criteria, quantity limits, step therapy requirements, and carve-out classifications for every drug on the list. This is manual, expert-reviewed work — not automated scraping.

For states in active development, a proprietary multi-agent framework generates preliminary formulary data using the state's program structure, MCO landscape, and known PDL patterns. These results are clearly labeled as AI-generated and include a notice to verify with the applicable plan before clinical use.

Three-Layer Search Architecture

Every query passes through a layered resolution system. The layer that responds depends on what verified data exists for that drug and state.

LAYER 1
Verified Database
Pharmacist-verified data exists for this drug in the selected state. Formulary status, PA criteria, quantity limits, step therapy, and carve-out classification are served directly from our database. This is the highest-confidence response available in the platform.
Response< 100ms
ConfidenceVerified
LAYER 2
Validated Cache
No verified database entry exists, but the drug has been searched recently for this state. The previous result is served from cache. Cache entries expire after 7 days to prevent stale data from reaching users. Labeled accordingly in the result.
Response< 200ms
ConfidenceRecent
LAYER 3
Multi-Agent Framework
No verified data or cached result exists. A proprietary multi-agent framework generates a formulary assessment using the state's program structure, MCO landscape, and known PDL patterns. Results are clearly labeled as AI-generated and include a notice to verify with the plan before clinical use.
Response3–6 seconds
ConfidenceAI-Generated
HIGH-RISK
High-Risk Drug Protection
Certain high-risk medications — Narrow Therapeutic Index drugs, controlled substances, and REMS-restricted drugs — are never served from the AI layer. If no verified database entry exists for these drugs, the system returns a notice to contact the plan directly rather than providing an estimate. The risk of an inaccurate result for these drugs is too high to permit an AI-generated response.
AI LayerDisabled
ProtectionActive

How a State Earns "Verified" Status

No state is marked as Verified until a licensed PharmD has completed a full review. The process is the same for every state, every time.

01The official state PDL is obtained directly from the state Medicaid authority — not from a third-party source or aggregator.
02A licensed PharmD reviews each drug entry against the PDL, recording formulary status, PA criteria, quantity limits, step therapy requirements, and carve-out classification for every drug.
03A 30-drug spot-check is performed by comparing FormCheckRx results to the official PDL document, line by line, for a random sample of 30 drugs across therapeutic classes.
04The pharmacist signs off on accuracy. The review is logged with the reviewer's credentials, the PDL version reviewed, and the date of sign-off.
05The state's status is changed to Verified and the verification date is recorded. The date is visible on every search result for that state.
06Verified states are re-reviewed when PDL changes are detected. Our monitoring system checks state PDL sources every 6 hours. Changes trigger a flagged review queue for pharmacist sign-off before the update goes live.

Six Safety Databases on Every Result

Safety flags are applied automatically to every search result, regardless of which layer served the formulary response. Staff should not need to maintain separate safety list subscriptions.

Database Edition Scope Count
AGS Beers Criteria 2023 Medications potentially inappropriate for adults 65+. Maintained by the American Geriatrics Society. Updated every three years. 46 drugs
ISMP High-Alert Medications 2024 Drugs bearing heightened risk of causing significant patient harm when used in error. Maintained by the Institute for Safe Medication Practices. 27 drugs
NIOSH Hazardous Drug List 2024 Occupational safety classifications for healthcare workers who handle, prepare, or administer these drugs. 23 drugs
Narrow Therapeutic Index Current Drugs where small changes in concentration can lead to therapeutic failure or toxicity. Requires precise dosing and monitoring. 11 drugs
FDA REMS Programs Current Risk Evaluation and Mitigation Strategies including prescriber certification, pharmacy certification, and patient enrollment requirements. 52 programs
ISMP LASA Pairs 2024 Look-alike/sound-alike drug name pairs that can be confused during prescribing, dispensing, or administration. 41 pairs

Reporting Incorrect Data

Report Incorrect Data

If you believe a FormCheckRx result is incorrect, a Report Incorrect Data option is available on every search result. Reports are reviewed by our pharmacist within one business day. Confirmed corrections are applied immediately and logged in our immutable audit trail.

We maintain a complete history of every formulary status change, including the previous value, new value, source of change, and timestamp. This audit trail is available to enterprise clients on request.

To report a data issue directly: [email protected]