Communication Letters

ConfigurationTenant adminLast updated:

The Communications tab is where you configure the templates, signer, and delivery settings for every letter your organization sends — to patients, prescribers, pharmacies, and carbon-copy recipients. Most letter types start off until you turn them on. Data-request letters, the prescriber therapy interchange move-to-preferred notice, and the prescriber legacy therapy discontinuation notice are always on; the patient and pharmacy copies of both notices start off and are optional.

Accessing Communication Letters

Tenant and global administrators — From Manage Tenant (or Tenant Management for global administrators), open the tenant detail page and select the Communications tab.

Other users who can configure the tenant — From the Settings gear menu, select Communication Letters.

Settings are organized into sub-tabs: Letter Signer, Letter Delivery, Letter Templates, Guideline Communications, and Send Pending Letters.

Letter signer

The Letter Signer sub-tab sets the name that appears at the bottom of every patient letter as the closing signature. Fill in:

  • Signer name — the full name of the signing clinician or staff member.
  • Credentials — professional credentials, such as Pharm.D, RN, or MD.
  • Title — the job title, such as Director of Clinical Operations.

Select Save to apply your changes.

Letter Delivery Service

The Letter Delivery sub-tab holds the shared delivery services GEMA uses to send letter PDFs to your organization. Today that means SFTP; other service types (such as mail) appear in the picker when you add a service but are marked coming soon until they are ready. You can keep several SFTP services — for example one for your nightly mailer and another for an overflow print shop — and each letter template set to SFTP chooses which connection it uses. Select Add Service, then choose a type:

  • SFTP — opens the connection form described below.
  • Mail — shown but not selectable yet (coming soon).

Each SFTP service has:

  • Connection name — how the connection appears when a letter template picks its destination. Names must be unique.
  • Enable this connection — turn the connection on when it is ready to receive letters.
  • Host, Port, and Username — where GEMA connects and who it signs in as.
  • SSH private key (PEM) — the preferred way to authenticate. Paste the full PEM block, including the BEGIN and END lines.
  • Password — a fallback for servers that do not accept SSH keys. Use it only when a key is not an option.
  • SFTP folder — the remote directory that receives manifest.csv, manifest.jsonl, and one PDF per letter.
  • Host key fingerprint — recommended. Enter the SHA256 fingerprint your server administrator provides so GEMA can verify the server’s identity before uploading letters. Connections without a fingerprint are flagged with a warning.

A connection must have a key or a password before it can be enabled. When you edit an existing connection, the key and password fields stay blank and the stored credential is kept — type a new value only when you want to replace it.

Use the pencil icon to edit a connection and the trash icon to remove one. When you turn Enable this connection off and select Update, if any enabled letter templates still use that connection, a confirmation lists those templates before the change is saved. Cancel keeps the form open with the switch off; Disable connection saves the change. When you remove a connection, the confirmation also lists any enabled letter templates that still use it; if none do, it tells you the connection is safe to remove. Removing a connection stops delivery for affected letters until you choose another SFTP connection. Adding, editing, and deleting each save immediately.

These services are only for letters. The daily reporting file you can send to your own SFTP server is set up separately, on Configurations → Data Warehouse, and uses its own folder.

Letter templates

The Letter Templates sub-tab lists every letter type your organization can send. Types start collapsed, each with a short description of when that letter is sent. Expand a type to see the recipients it can reach (patient, prescriber, or pharmacy, depending on the letter). Expand a recipient to edit that letter.

Letter types include initiation, GoldCard initiation, continuation, rejection, GoldCard rejection, discontinue, excluded medication, appeal denied, abandonment, data request, excluded brand data request, GoldCard data request, therapy interchange data request, therapy interchange move to preferred, legacy therapy discontinuation data request, and legacy therapy discontinuation.

Excluded medication has a prescriber letter and a pharmacy letter. There is no patient letter. The pharmacy letter starts on, and it is created only when Fax pharmacy is on for the exclusion, its formulary, or your organization. You can edit the wording, subject, and destination of each letter.

Each guideline workflow that sends a data request or a GoldCard approval or denial has its own top-level letter type. The wording you see in the editor is the wording that letter will use — there are no hidden branches that swap in different prose at send time.

For each recipient you can:

  • Edit the letter body using the template editor, which supports merge fields (variables like {{signer.name}}, {{signer.credentials}}, and {{signer.title}} that are filled in automatically when a letter is generated).
  • Set the subject and, where applicable, the delivery destination.
  • When the destination is SFTP, choose the SFTP connection that letter uses. The picker lists enabled connections from Letter Delivery Service. Leave it blank to use your default connection, or pick one to be explicit. If no connections exist yet, the editor tells you to add one under Letter Delivery Service first. If a previously chosen connection was disabled, clear it or pick another — disabled connections are not offered.
  • Turn the letter on or off with Enable this letter. Turning a letter on or off saves immediately.

If you turn on a letter that does not yet have wording saved for your organization, the editor shows the current system default, and generated letters use that same default until you change and save the body. You do not need to save the default wording merely to turn the letter on. Select Save (the button named for that letter type and recipient) when you have edited the body, subject, or delivery destination.

Defaults and always-on letters

Most letters start off by default, so nothing is sent until you review the wording and turn it on. These notices are always on and cannot be turned off:

  • Data request — required to keep standard prior authorization reviews moving. Its enable toggle appears switched on and greyed out. You can still edit its body, subject, and destination.
  • Excluded brand data request — required when the prescribed brand is not covered and the review needs more clinical information alongside the excluded-brand substitution details. Always on; you can edit its body, subject, and destination.
  • GoldCard data request — the proactive data request sent ahead of a prescription rejection for members in a GoldCard program. Always on; you can edit its body, subject, and destination.
  • Therapy interchange data request — sent to the prescriber when a continuation-style therapeutic interchange review cannot be decided from the information on file. It requests the clinical information needed to finish the review. If the request expires, a 30-day refill block is queued and therapy should move to the preferred alternative. Always on; you can edit its body, subject, and destination.
  • Legacy therapy discontinuation data request — sent to the prescriber when a legacy therapy review cannot be decided from the information on file. It requests the clinical information needed to finish the review. If the request expires, a 30-day refill block is queued and the therapy is discontinued. No replacement medication is named, because this program ends the therapy rather than substituting another drug. Always on; you can edit its body, subject, and destination.
  • Therapy interchange move to preferred — prescriber — required when a member does not meet the therapeutic interchange criteria, or when the data request expires. A 30-day refill block is queued for the source drug and therapy should move to the preferred formulary alternative.
  • Legacy therapy discontinuation — prescriber — required when a member does not meet the continuation criteria for a legacy therapy review, or when the data request expires. A 30-day refill block is queued and the therapy is discontinued with no replacement medication, so the prescriber needs the notice to review the patient’s care plan.

The patient and pharmacy copies of the move-to-preferred and legacy therapy discontinuation notices are optional and start off. Turn either recipient on when your organization wants that notice created. Every recipient of both notices uses fixed system wording that cannot be customized; you can still configure the subject and delivery destination.

A member who does meet the criteria for either program stays on their current medication and receives no letter at all.

If a required notice was previously saved in the off state, it now shows as on and stays on. Saved on/off choices for the optional patient and pharmacy notices are honored.

Data request letters — standard, excluded brand, GoldCard, therapy interchange, and legacy therapy discontinuation — each have a single prescriber template. If a carbon-copy recipient is configured for your organization, that copy is delivered using the same body and subject as the prescriber template — there is no separate carbon-copy template to configure.

GoldCard initiation and GoldCard rejection are separate from the standard initiation and rejection letters. Configure them when your organization sends proactive GoldCard approval or denial notices to the patient, prescriber, and pharmacy. Each starts off until you turn it on, the same as the standard approval and denial letters.

Guideline-level overrides

Within each guideline you can override letter settings for that guideline only. The override panel uses the same collapsed list: expand a letter type, then a recipient, to edit. For editable letters you choose whether to inherit the organization default or turn the letter on or off for that guideline. Required data requests, the prescriber therapy interchange move-to-preferred notice, and the prescriber legacy therapy discontinuation notice show an Always on indicator instead of an enable toggle.

Each expanded recipient shows a short line telling you how that letter reaches its recipient — for example “Delivered by fax”, “Delivered by email”, “Delivered by secure file transfer”, “Delivered by mail vendor”, or “Downloaded and printed manually”. The Email subject override field only appears for letters that are actually delivered by email, since a subject line has nowhere to appear on a faxed, mailed, or printed letter. If you change a letter’s delivery to something other than email, any subject you saved earlier is kept and simply hidden; switch the delivery back to email and it reappears.

Below that you fill in the guideline-specific wording fields your organization’s letter body asks for. If the letter body has none, you will see a note saying the letter has no guideline-specific fields to fill in, along with a reminder that your tenant admin can add {{slot.name}} placeholders to the letter body when you need per-guideline wording.

Select Save in the templates section to apply your template changes.

Sending pending letters

The Send Pending Letters sub-tab lets you control when queued letters are delivered:

  • Preview (dry run) — shows how many letters would be sent and to which destination, without actually delivering them. Use this to verify your delivery settings before committing.
  • Send now — immediately delivers all pending letters using your configured delivery settings. Normally, pending letters are delivered automatically each day at 03:00 UTC.

After either action, a summary message shows the number of letters found, delivered, and any errors encountered. If nothing can be sent because no connection is ready, the message asks you to add and enable an SFTP connection under Letter Delivery Service.