Quick Fact


The quality of our clinical guidelines leads to solid coverage decisions that are rarely overturned on appeal.

Clinical Guideline Development

To complement your organization’s prior authorization system, Clinical Pharmacy Services develops clinical guidelines for those making coverage decisions on those drugs. We have a library of more than 400 guidelines.

Our clinical pharmacists have specialized training that enables them to search for, retrieve, evaluate, and interpret a wide range of published medical literature, including clinical studies, published literature, and advisories.

In addition to scanning all available clinical resources to develop guidelines for specific clients, we also take a proactive approach:

  • Remain aware of clinical developments that could result in changes to guideline status
  • Collaborate with you to ensure the resulting clinical guidelines reflect your organization’s unique needs
  • Take physician viewpoints into account throughout the guideline development process

Our approach to guideline development is as follows:

  • Align guideline with accepted best practices and available evidence-based information
  • Present guideline to you for approval
  • Monitor the impact of the clinical guideline for six months
  • Evaluate whether the guideline works well
  • Eliminate or redesign guideline as necessary

The guidelines are designed so they can be used either as internal review documents or within a published service guide, such as a web document. We also host forums and continuing education programs to provide clients with clinical updates.