Configuring Guidelines

Guidelines & Evaluations Last updated:

This area is available to users with guideline configuration access.

Accessing Guideline Configuration

From the left navigation, select the Settings gear icon, then choose Guideline Configuration. The page opens to the Guidelines tab showing all guidelines configured for your business unit.

The Guidelines List

The guidelines list displays all guidelines your business unit has access to. You can:

  • Search by typing in the search field at the top of the table
  • Filter by type using the All / Guidelines / Exclusions toggle above the list
  • Filter by business unit using the business unit filter (visible if your account spans multiple units)

Each row in the table shows the guideline name, type (Guideline or Exclusion), active status, and the business units it applies to. Click any row to open the guideline’s detail page.

Row actions

Hovering over a guideline row reveals action icons:

  • Edit — opens the Edit Guideline panel so you can update settings
  • Clone — opens the Clone dialog to copy this guideline under a new name
  • Manage Business Units — controls which business units the guideline is assigned to
  • Delete — permanently removes the guideline (requires confirmation)

Adding a Guideline

Click Add Guideline in the upper right of the Guidelines tab. A panel slides in with a multi-step wizard.

Step 1 — Upload Document

You are prompted to either:

  • Upload a clinical document (PDF or supported file) — the system parses the document to extract rule suggestions. After uploading, the wizard advances automatically to Step 2.
  • Create an Exclusion — select this option to configure a drug exclusion rule without uploading a document. The wizard skips directly to the Configure step.

Step 2 — Process & Select Guideline

After a document is processed, you see the parsed content alongside a list of matching guideline templates. Select the guideline that best matches the clinical criteria in the document, then click Next.

Step 3 — Configure Guideline

In the final step you set:

  • Basic details — name, indication, drug targets, tags
  • Initiation rules — the clinical criteria a patient must meet to start therapy
  • Continuation rules — the criteria required to continue an approved therapy
  • Formulary assignment — which formulary manages this guideline
  • Contact settings — how prescribers, patients, and pharmacies are contacted when this guideline generates a prior authorization task
  • Letter overrides — custom letter content if your organization needs non-default messaging

Click Save to create the guideline. It appears immediately in the Guidelines list.

Editing a Guideline

Click the Edit action on any guideline row, or open the guideline’s detail page and use the edit action there. The same three-step panel opens, starting at the Configure step with your existing settings pre-filled. Make your changes and click Save.

Cloning a Guideline

Click the Clone action on a guideline row. A dialog asks you for a name for the copy. The clone inherits all rules, formulary assignments, and contact settings from the original. You can edit the clone independently after it is created.

Adopting from the Library

If your account has access to the Library tab (visible for most tenants), you can adopt pre-built guideline templates maintained by your organization’s global team.

  1. Click the Library tab at the top of the Guideline Configuration page.
  2. Browse or search the available templates.
  3. Click Adopt on any template you want to use. The system copies it into your Guidelines tab, where you can configure it for your business unit.