Configuring Guidelines

Guidelines & EvaluationsLast updated: 2026-10-07

This area is available to users with guideline configuration access.

Accessing Guideline Manager

From the header, select the Settings gear icon, then choose Guideline Manager. 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 / Interchange / Legacy Therapy Discontinuation / GoldCard toggle above the list
Filter by business unit using the business unit filter (visible if your account spans multiple units)
Select multiple rows with the checkboxes. Below the search bar, text links appear for bulk actions: Tags (opens a dialog to merge reporting tags onto the selection), Disable (asks for confirmation, then turns the guidelines off), and Delete (asks for confirmation, then permanently removes them). Use Clear to drop the selection.

Each row in the table shows the guideline name, type (Guideline, Exclusion, Interchange, Legacy Therapy Discontinuation, or GoldCard), active status, a Description truncated to five lines when it is longer, business units, and a Last Evaluated timestamp showing when the most recent population-level evaluation completed. Click any row to open the guideline’s detail page. On the detail page, Therapeutic Interchange records show an Interchange type chip plus Source Drug and Preferred Drug in Basic Information. The info banner explains the daily continuation-style review: members who meet the rules have a source authorization queued; members who fail have a 30-day refill block queued and receive the required prescriber move-to-preferred notice; patient and pharmacy notices are optional. Missing data opens a TI data request, and an expired request queues the same refill block. Legacy Therapy Discontinuation records show a Legacy Therapy Discontinuation type chip plus the Source Drug in Basic Information — there is no preferred or target drug, because this program ends the therapy rather than substituting another one. Its info banner explains the same daily review with the discontinuation ending: members who meet the rules have a source authorization queued; members who fail are taken off the therapy with no replacement, have a 30-day refill block queued, and the prescriber receives the required discontinuation notice. When a source authorization is configured, a Source Authorization Settings card shows the identifier method, code, and duration used on that submission. GoldCard records show a GoldCard type chip plus the Target Drug, and an info banner at the top explains that these configs are not run manually — a scheduled job checks your selected population against the matching rules, and members who clearly match are put through prior authorization automatically.

The detail page heading carries the title, so Basic Information covers only the drugs, indication, codes, and Reporting tags (shown as chips when any are assigned). The Metadata card lists the business units the record is assigned to — by name, not by ID — along with any formularies that manage it. For standard guidelines, it also shows any business units excluded from initiation or continuation. If the record has neither business units nor formularies, the card says so. When available, the Metadata card also shows a Created timestamp and an Updated timestamp indicating when the record was first saved and most recently changed. These rows are omitted for older records that pre-date timestamp tracking.

The Rules section appears only when there are rules to read. Each card shows a plain-language summary of the matching, initiation, continuation, or interchange rules. Standard-guideline Matching Rules show readable prescriber taxonomy names with their codes, plus any route-of-administration or dosage-form restrictions you configured. When a rule references a reusable ontology rule, the summary names that ontology rule (for example, Patient matches ontology rule: Type 2 Diabetes) instead of showing a raw rule ID. A Therapeutic Interchange with no interchange rules shows an Interchange Rules card stating that all members on the source drug may stay on source, instead of an empty rules panel. A Legacy Therapy Discontinuation shows a Discontinuation Rules card with a closing line reminding you that members who meet the criteria stay on the source drug and members who do not are taken off that therapy with no replacement drug; with no rules configured, the card states that every member on the source drug stays on the therapy. A GoldCard config shows Matching Rules — the population gate used before any prior authorization is started.

Row actions

Hovering over a guideline row reveals action icons:

Edit — opens a panel headed Edit Guideline - Prior Authorization, Edit Guideline - Exclusion, Edit Guideline - Interchange, Edit Guideline - Legacy Therapy Discontinuation, or Edit Guideline - GoldCard, matching the row type, so you can update settings (for Therapeutic Interchange rows, this opens the interchange configuration; for Legacy Therapy Discontinuation rows, this opens the discontinuation configuration; for GoldCard rows, this opens the GoldCard configuration)
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)

Three additional actions appear on any guideline whose title is shown in red (meaning the global template it was adopted from has been updated):

Preview Global Version — opens a side panel showing the current global template content so you can compare it with your copy
Adopt Update — overwrites your copy’s content with the latest global version; if the update adds references to ontology rules you do not yet have, those rules are adopted the same way as when you first adopt from the Library (rules you already adopted are reused); the title returns to normal color
Decline Update — dismisses the update notification and keeps your current version unchanged; the title returns to normal color until the global version is updated again

Update notifications

When the global team updates a guideline template that you have previously adopted, the guideline’s title turns red with an alert icon in your list. This indicates your copy is out of date. You can take action at any time using the row actions above; clicking Cancel in either dialog leaves the notification active for later review.

Adding a Configuration

Click Add in the upper right of the Guidelines tab. A new page opens titled Start a new guideline. Choose a type, then click Continue:

Guideline — upload a clinical document, pick the indication to build, then configure prior-authorization rules
AI Authored Guideline (marked New) — describe a title, drug, and indication; AI writes the document and rules; you review them, then configure
Excluded Drugs — configure a formulary exclusion without uploading a document
Therapeutic Interchange — configure a source-to-preferred drug conversion for a business-unit population
Legacy Therapy Discontinuation — review members on a source drug and discontinue that therapy with no replacement when they fail the criteria
GoldCard — configure proactive prior-authorization matching for a target drug across a business-unit population

Days Supply and Quantity Limits are not available from this menu.

AI guideline authoring is off until an Ethicos administrator turns it on. When it is off for your account, the AI Authored Guideline card on this screen is unavailable — it stays visible but greyed out and cannot be selected. Opening an in-progress AI draft while this setting is off returns you to Start a new guideline with Guideline selected, and that draft is not left open on the page. Tenant administrators see the current setting under Manage Tenant → Configurations → Guidelines (AI guideline authoring); only an Ethicos administrator can change it. The same setting disables Regenerate document on the guideline detail page and the matching action on the source document in edit mode (those buttons stay visible but cannot be used).

A step list at the top shows where you are: Type / Source / Indication / Customize for a document upload, Type / Source / Iterate / Customize for AI, or Type / Customize for Excluded Drugs, Therapeutic Interchange, Legacy Therapy Discontinuation, and GoldCard. Click an earlier step to go back. Returning to Type clears the document, form fields, and other values from later steps so you start that create over. Clicking Source while a write or an analysis is still running leaves that job running. The title, drug, indication, and section seeds stay unavailable until it finishes. When it finishes, the page shows the finished draft — Review the document for an AI write, or Select the indication to build for an upload.

If you leave during AI generation, you can reopen the same link later and pick up where the document left off. A document-upload guideline stays on the create page — leaving or refreshing starts that create over.

Adding a Guideline

After you choose Guideline and click Continue, the title becomes Upload the source document.

Use the dashed drop area or Choose a file to pick a PDF or DOC (up to 40 MB). As soon as you pick the file, the title becomes Analyzing the document and a single progress bar runs for the whole wait — first the transfer, then the analysis. The line under the bar tells you which part is happening. You can leave this page — the job keeps running, and you are notified when it finishes. Clicking Source during that wait also leaves the job running, and when analysis finishes the page shows Select the indication to build. If the transfer does not finish within about a minute, you are returned to the upload step with an error asking you to check your connection and try again. A processing failure shows as a red error without sending you back.

When processing succeeds, the title becomes Select the indication to build. Each candidate is one drug and one indication; selecting one carries its codes into the details form. The source document starts hidden — click Open document if you want to see the uploaded file. Select one candidate and click Continue to details. Back returns you to Upload the source document and keeps those indications. Click Indication in the step list, or Continue to indications, to open the same choices again.

The last step is Confirm guideline details. Use the left Sections list to open one area at a time — the same layout as edit:

Details — name, indication, drug targets, Reporting tags, description, notes, and whether the guideline is enabled
Access — business units or formulary assignment, benefit type, administration, and Indication codes. ICD codes suggested from the uploaded document appear here so you can review them, add or remove codes, or clear the list. This is optional and does not block saving. If the business units for a selected formulary have not loaded, a note under the picker says so and Save stays available, so you can click it to retry loading them
Rules — initiation rules (the clinical criteria a patient must meet to start therapy) and continuation rules (the criteria required to continue an approved therapy)
Communications — how prescribers, patients, and pharmacies are contacted, plus letter overrides if your organization needs non-default messaging
Medication Configuration — how the prior-authorization medication is selected
Duration Settings — how long approvals last and when continuation runs

Both the Initiation Rules and Continuation Rules builders are available in Rules, whether or not the guideline already has rules of that kind. If a guideline was saved with no initiation criteria, you can still open it later and add them.

Click Create Guideline to save. You go to the new guideline’s details page. The row also appears in the Guidelines list. Back from that details page returns you to the Guidelines list, not the create page. Excluded Drugs, Therapeutic Interchange, and GoldCard do not show this indication-codes review.

Use Reporting tags in Details to pick labels from your tenant’s managed catalog or type a new tag and press Enter. Tags you type here are saved on this guideline only until a tenant administrator adds them under Tenant → Configurations → Guidelines → Reporting Tags.

Exclude from initiation and Exclude from continuation let you remove business units from either phase. You can select only units in the current population. These carve-outs do not hide the guideline or replace its business-unit or formulary assignment.

The Matching Rules, Initiation Rules, and Continuation Rules builders are always shown for a standard guideline, whether or not it already has rules of that kind. Matching Rules are optional: leaving them empty means no restriction — the guideline applies to every prescriber and every dosage form of the drug after the drug match. When you do add matching rules, you can combine prescriber taxonomy, route of administration, and dosage form using and, or, and not groups. Each leaf uses is one of or is not one of. Every group you add must contain at least one rule, and a not group must contain exactly one rule. If JSON or Describe adds an incomplete group or a clinical criterion there, Save explains that it must be corrected or cleared. When a patient’s medication, prescriber, or claim does not satisfy your matching rules, that guideline is skipped for that evaluation — it does not run clinical rules, does not produce a determination, and does not open a data request. The same skip applies when the information needed to decide is unavailable (for example a missing prescriber NPI, unknown prescriber taxonomy, or a claim with no route or dosage form when you restricted by route or form). Excluded Drugs, Therapeutic Interchange, and GoldCard use their existing configuration screens and do not show this standard-guideline Matching Rules builder.

Each builder has Builder, JSON, and Describe tabs. Use Describe to write a plain-language description, then select Generate Rules. The generated rules appear in the Builder tab — this works the same way for Initiation Rules and Continuation Rules.

When Describe Rules is not enabled for your tenant, the Describe tab appears greyed out and Generate Rules is disabled. The Builder and JSON tabs keep working. A global administrator can turn this on in Tenant Details, on the Configurations → Guidelines sub-tab (Enable Describe Rules (AI rule generation)).

If the AI cannot produce any rules from your description, you see: The AI could not generate rules from this description. Try rephrasing or shortening it. Existing rules in the builder are left unchanged.

Adding an AI Authored Guideline

After you choose AI Authored Guideline and click Continue, the title becomes Describe the guideline to write. Enter a title, then a drug, then an indication — each field is full width, one under the next. Under Title, Auto-format from drug and indication fills the title from the drug and indication you entered. Back and Generate document stay at the bottom of the form while the fields above scroll. If no drug is selected, that bar shows a warning instead of the seed summary. Shape the document lists Overview, Pharmacology, Toxicity, Dosing, and References. With a drug selected and no sections seeded, the footer reads No sections seeded. Click Generate document.

The page shows Writing the document while the job runs. A single progress bar and the current job status sit under that title. You can leave — the job keeps running, and you can return to the same document later. Clicking Source during the write also leaves the job running. The title, drug, indication, and section seeds on that form stay unavailable until the write finishes. When the write finishes, the page shows Review the document and the finished draft. If you are on Source and a finished draft is already there, click Iterate to return to that review. Iterate is not available while a write is still running. Generate document on Source stays unavailable while the title, drug, indication, and section seeds still match that finished draft. If the write fails, Generate document is available again for the same title, drug, and indication. Generate document stays unavailable until an in-flight write finishes, so a second write does not start on top of the first.

When generation finishes, the title becomes Review the document. The left side is the same source form you filled in — title, drug, and indication stacked, then Shape the document. The generated document is open on the right — click Hide document if you want more room for the form. Back, Reset, Regenerate document, and Accept document stay at the bottom. When no section seeds are filled in, the footer reads No sections seeded. Regenerate document stays unavailable until the title, drug, indication, or a section seed differs from the current draft. It then saves those edited values on the draft and rewrites the document from them, keeping you on the same review step — it does not create a separate guideline. While that rewrite runs, the title is Regenerating the document, and the title, drug, indication, and section seeds stay unavailable. Accept document stays unavailable while a rewrite is still running. While the title, drug, indication, or a section seed differs from the draft, Accept document stays unavailable. Put those fields back to the draft, or click Reset, and Accept document is available again. Reset puts back the title, drug, indication, and section seeds the current draft was written from. While the source matches that draft, the form says Document matches the current source and rules. When the document already has one set of initiation or continuation rules, Accept document opens Confirm guideline details with those rules in the builders. When it has more than one set, the title becomes Select the indication to build. Choose one and click Continue to details. Back returns you to Review the document. When the document does not have rules yet, the title becomes Extracting rules and the page shows Extracting rules from the document… with a progress bar while rules are read from the document you are reviewing. Clicking Source during that wait leaves the job running. The title, drug, indication, and section seeds stay unavailable, and Generate document and Accept document stay unavailable until it finishes. You then land on Confirm guideline details with those rules filled in, or on Select the indication to build when more than one set is found. If rules cannot be produced, you still reach Confirm guideline details and the initiation and continuation builders are empty so you can write them there. On Confirm guideline details, add indication codes in Indication codes before you save. This is optional and does not block saving.

Then Confirm guideline details uses the same sectioned configuration as a document-upload guideline — the left Sections list and one section at a time. Click Create Guideline to save. You go to the new guideline’s details page.

Publishing a guideline publicly

Under the Enable this guideline switch there is a second switch, Publish on public formulary pages. Turn it on to show this guideline’s title, description, and document on every published formulary page that includes it. The hint under the switch reminds you that this does not change automatic matching.

The two switches are independent, and both start off:

Enable this guideline controls whether the guideline is matched automatically during evaluations.
Publish on public formulary pages controls only whether the public sees it. A guideline can be enabled but unpublished (used internally, not shown publicly), or published but disabled (shown for reference, not matched automatically).

A guideline appears on a public formulary page only when the guideline is published and the formulary that includes it is published with a public URL slug. See Formularies for the formulary side of that setup.

This switch is not offered for Excluded Drugs configurations.

Adding Excluded Drugs

After you choose Excluded Drugs and click Continue, Confirm guideline details opens directly (no document upload) with the left Sections list. Open Excluded Medication to set the excluded drug tokens, Reporting tags if needed, and whether the exclusion is enabled. Open Access. Under Business unit access, choose either Business Units to select the population directly or Formulary to use the managed business units from one or more formularies. A selected formulary must manage at least one business unit. Also choose Benefit type — whether the exclusion applies to medical benefits, pharmacy benefits, or both — and Administration — self administered, office administered, or either. Open Communication Messages to configure the replacement medication, prescriber message, description, and pharmacy notice. Fax pharmacy controls whether the pharmacy also receives the exclusion notice: Default (inherit) follows the formulary or your organization’s setting, Yes — fax pharmacy sends it, and No — do not fax pharmacy does not. When the pharmacy is faxed, Pharmacy Contact appears: Default (inherit) follows the formulary or your organization’s setting, Automatic sends the pharmacy letter without waiting for staff, and Manual holds it for you to send. The prescriber always receives the exclusion letter. An exclusion does not send a patient letter. Required fields in that section use a red asterisk. Until those are filled, a short list at the bottom of the Sections list tells you what is still needed. Click Create Exclusion to save. You go to the new exclusion’s details page, and the list shows it with an Exclusion type chip.

Adding a Therapeutic Interchange

After you choose Therapeutic Interchange and click Continue, Confirm guideline details uses the left Sections list so you work in one section at a time. An info banner explains the daily continuation-style review: a passing member has a source authorization queued without a letter; a failing member has a 30-day refill block queued and receives the required prescriber move-to-preferred notice, with patient and pharmacy notices optional. Missing information opens a TI data request; if it expires, the refill block is queued. The sections are:

Source and Preferred Drug — pick exactly one source drug and exactly one preferred drug. Searching a medication offers a row for each scope: Either Brand or Generic, Generic, Any Brand, and a row for each specific brand found (for example Semaglutide (Brand: Ozempic)). Choose the row that matches the therapy you mean — picking a specific brand targets only members on that brand, so Ozempic and Wegovy stay distinct even though they share an ingredient. Each field accepts one selection, and the chip shows the scope you chose. The title and description are auto-generated from those selections in the same readable form and remain editable. Assign Reporting tags the same way as on a standard guideline (catalog suggestions or a new tag). Toggle whether the interchange is enabled. When the interchange is disabled, a hint under the toggle notes that disabled interchanges are skipped by the scheduled run.
Population — choose Benefit type — whether the interchange applies to medical benefits, pharmacy benefits, or both. Under Business unit access, choose either Business Units to select the population directly or Formulary to use the combined managed business units from one or more formularies. A selected formulary must manage at least one business unit.
Source Authorization Settings — configure how the source drug is identified when submitting a prior authorization for members who pass the interchange rules and stay on source. Select an identifier method — GPI (Generic Product Identifier), DDID (Drug Dispensing ID), or NDC (National Drug Code) — and enter the corresponding code. Set the Source Authorization Duration (days) (default 180) to control how long a source authorization remains valid before re-evaluation is required. This section is required when the interchange is enabled; an incomplete configuration blocks saving an enabled interchange.
Interchange Rules — build the rules that decide whether a member may stay on source, must move to the preferred drug, or needs additional clinical data (the same rule builder used for guidelines). Incomplete rules block save until you finish or clear them. Rules are evaluated as continuation-style criteria applied to each member’s current therapy.

Until the required fields are filled, a short list at the bottom of the Sections list tells you what is still needed (source drug, preferred drug, title, business-unit or formulary access, source authorization method and code when enabled, or incomplete rules). When the note says the formulary business units have not loaded, Create Interchange stays clickable — click it to retry loading them. Click Create Interchange to save. You go to the new interchange’s details page, which labels it Interchange and shows the source and preferred drugs. The list row has an Interchange type chip. There is no Play / Run action on the list for interchange configs — the daily scheduled run handles outreach once the interchange is enabled.

Adding a Legacy Therapy Discontinuation

After you choose Legacy Therapy Discontinuation and click Continue, Confirm guideline details uses the left Sections list so you work in one section at a time. An info banner explains the daily continuation-style review: a passing member has a source authorization queued; a failing member is taken off the source therapy with no replacement, has a 30-day refill block queued, and receives the required prescriber discontinuation notice, with patient and pharmacy notices optional. Missing information opens a discontinuation data request; if it expires, the refill block is queued. The sections are:

Source Drug — pick exactly one source drug. Searching a medication offers a row for each scope: Either Brand or Generic, Generic, Any Brand, and a row for each specific brand found. Choose the row that matches the therapy you mean. The field accepts one selection, and the chip shows the scope you chose. The title and description are auto-generated from that selection in readable form and remain editable. Toggle whether the program is enabled. When the program is disabled, a hint under the toggle notes that disabled programs are skipped by the scheduled run.
Population — choose Benefit type — whether the program applies to medical benefits, pharmacy benefits, or both. Under Business unit access, choose either Business Units to select the population directly or Formulary to use the combined managed business units from one or more formularies. A selected formulary must manage at least one business unit.
Source Authorization Settings — configure how the source drug is identified when submitting a prior authorization for members who pass the rules and stay on source. Select an identifier method — GPI (Generic Product Identifier), DDID (Drug Dispensing ID), or NDC (National Drug Code) — and enter the corresponding code. Set the Source Authorization Duration (days) (default 180) to control how long a source authorization remains valid before re-evaluation is required. This section is required when the program is enabled; an incomplete configuration blocks saving an enabled program.
Discontinuation Rules — build the rules that decide whether a member may stay on source, must discontinue the source therapy with no replacement, or needs additional clinical data (the same rule builder used for guidelines). Incomplete rules block save until you finish or clear them. Rules are evaluated as continuation-style criteria applied to each member’s current therapy.

Until the required fields are filled, a short list at the bottom of the Sections list tells you what is still needed (source drug, title, business-unit or formulary access, source authorization method and code when enabled, or incomplete rules). It is headed Before you can save:. When the note says the formulary business units have not loaded, Create Discontinuation stays clickable — click it to retry loading them. Click Create Discontinuation to save. The new row appears in the list with a Legacy Therapy Discontinuation type chip. There is no Play / Run action on the list for these configs — the daily scheduled run handles outreach once the program is enabled.

Adding a GoldCard

After you choose GoldCard and click Continue, Confirm guideline details uses the left Sections list so you work in one section at a time. An info banner at the top explains that these configs are not run manually — a scheduled job checks your selected population against the matching rules, and members who clearly match are put through prior authorization automatically. The sections are:

Target — pick exactly one target drug, set the title and description (the title is auto-generated from the drug and remains editable), assign Reporting tags if needed, and toggle whether the config is enabled. Searching a medication offers the same brand/generic scope rows used elsewhere — choose the row that matches the therapy you mean. When the config is disabled, a hint under the toggle notes that disabled configs are skipped by the scheduled run.
Population — choose Benefit type — whether the config applies to medical benefits, pharmacy benefits, or both. Under Business unit access, choose either Business Units to select the population directly or Formulary to use the combined managed business units from one or more formularies. A selected formulary must manage at least one business unit.
Matching Rules — build the rules that decide which patients are candidates for proactive prior authorization. Matching is a gate: only an explicit match proceeds to evaluation. Patients who fail the rules, or who are missing the data needed to decide, are skipped — missing data does not trigger a data-request fax.

Until the required fields are filled, a short list at the bottom of the Sections list tells you what is still needed (target drug, title, business-unit or formulary access, or incomplete matching rules). When the note says the formulary business units have not loaded, Create GoldCard stays clickable — click it to retry loading them. Click Create GoldCard to save. You go to the new GoldCard’s details page. The list row has a GoldCard type chip. GoldCard configs run on a schedule automatically — there is no Play / Run action on the list for them.

Editing a Guideline

Click the Edit action on any guideline row. A details panel slides in from the right. The heading is Edit Guideline - Prior Authorization, Edit Guideline - Exclusion, Edit Guideline - Interchange, Edit Guideline - Legacy Therapy Discontinuation, or Edit Guideline - GoldCard, matching the row type — not the guideline name. The form does not repeat a second Configure Guideline, Configure Excluded Medication, Edit Therapeutic Interchange, or Edit GoldCard title under that heading. A numbered section list on the left lets you jump between settings without scrolling a single long form. Longer names wrap onto additional lines so the full label stays readable. The Guidelines and Library tabs stay on the page behind the panel.

For Guideline rows, the panel has six sections: Details (title, drugs, indication, Reporting tags, description, notes, enablement, the periodic continuation toggle, and the source document with Download / Replace document), Access (business units or formulary, benefit type, and pharmacy network when your tenant has one), Rules, Communications (prescriber, patient, and pharmacy contact settings, plus messages and letter overrides), Medication Configuration, and Duration Settings (including the continuation evaluation period and task due days). The continuation evaluation period is editable only while periodic continuation is enabled; Subsequent PA Duration is locked to that same period while continuation is on. Indication codes already stored on the guideline appear as read-only chips in Access — they are saved with the record but not edited here. Each access mode keeps its own carve-outs, so switching between Business Units and Formulary to compare them does not clear what you already selected. Whichever mode is showing when you save is the one that is saved, and carve-outs outside that population are removed. When a source document is attached, Replace document uploads a new file without changing your rules. The button shows a loading state while the new file uploads and its text is extracted. Regenerate document opens a page where you enter the title, drug, indication, and any section seeds, then start the draft. While that draft is being written, and while Accept document is sending, those fields stay unavailable. Save rule changes first — the draft uses the saved rules, not unsaved edits in this panel. When the current document can be previewed, that preview stays on the page until the new draft is rendered. On a wide page it sits beside the form. On a narrow page it sits under the form and above Discard draft, Regenerate again, and Accept document. Regenerate again stays unavailable until you change the title, drug, indication, or a section seed from the draft on screen. The current document stays the guideline’s document until you accept the draft. Discard draft leaves the current document as it is. After you save, if those rules no longer match the document, the same note appears on the source document and on the guideline’s detail page.
For Exclusion rows, the panel has three sections: Excluded Medication (title, drug tokens, Reporting tags, and enablement), Access (including the saved Business Units or Formulary access mode), and Communication Messages (replacement medication, prescriber message, description, Fax pharmacy, Pharmacy Contact, and messages). Pharmacy Contact appears unless Fax pharmacy is set to No — do not fax pharmacy. The saved values show when you reopen the panel. Exclusions cannot be published on public formulary pages.
For Interchange rows, the panel has Source and Preferred Drug, Population, Source Authorization Settings, and Interchange Rules. Existing source/preferred drugs, Reporting tags, benefit type, Business Units or Formulary access, source authorization settings, and rules are pre-filled. Each drug chip re-opens with the brand or generic scope you originally saved. The same scheduled-run info banner appears at the top of the panel.
For Legacy Therapy Discontinuation rows, the discontinuation configuration opens with the existing source drug, benefit type, Business Units or Formulary access mode, source authorization settings, and rules pre-filled. The source drug chip re-opens with the brand or generic scope you originally saved. The same scheduled-run info banner appears at the top of the panel.
For GoldCard rows, the panel has Target, Population, and Matching Rules. Existing target drug, Reporting tags, benefit type, Business Units or Formulary access mode, and matching rules are pre-filled. The same scheduled-run info banner appears at the top of the panel.

When a section is still missing something, its number is replaced by an alert icon. Incomplete initiation or continuation rules flag Rules the same way and keep Update Guideline disabled until you finish or clear those rules — click Rules in the list to open that section. Interchange, Legacy Therapy Discontinuation, and GoldCard edit panels do the same for their rules. If an update button is greyed out, read the list at the bottom of Sections. It is headed Before you can save: and names what is still missing. Make your changes and click Update Guideline, Update Exclusion, Update Interchange, Update Discontinuation, or Update GoldCard. Adding a new configuration uses Add, which opens the Start a new guideline page described above.

Reviewing Evidence Checks

When you open a guideline, the Evidence Checks section shows the latest evidence review and its history. Open a check to read the reviewer summary, compare the current evidence with your guideline, and follow its source links. When the latest check is resolved, select View resolved check to open its read-only summary.

Evidence checks are available only when your account has this feature enabled. If it is unavailable, the guideline list does not show Evidence controls and the guideline detail page explains that the feature is unavailable. Any previous runs remain visible so you can review their results and resolve existing conflicts.

Evidence checks read a clinical document, so they apply to standard guidelines only. Exclusion, Interchange, Legacy Therapy Discontinuation, and GoldCard rows show N/A in the Evidence Status column and have no Evidence Checks section on their detail pages.

If a check reports a warning, tenant administrators can select Resolve after reviewing the conflicts. The same Resolve action is available in the warning banner when you edit the guideline; it takes you to the Evidence Checks review so you can inspect the conflicts before resolving them. Resolved checks show Resolved and remain in the check history. Select View resolved check to review a read-only record of the conflicts that were originally detected, including their explanations and source links. Resolved checks do not offer Resolve, but tenant administrators can still select Re-run from the resolved check dialog to start another check.

If a check has never run, or the latest result is clear, global administrators see Run evidence check on the latest card to start a new check without opening a dialog. If a check fails, tenant administrators can select Re-run directly on the latest card (no modal required). You can also open a failed check and select Re-run from the dialog. After starting a check or re-run, the Evidence Checks section shows its running status and, when available, a description and step-by-step progress count. If you leave and return while a check is running, the section reconnects to its live progress. If the live status connection is interrupted, the section refreshes the latest result. Failed checks do not offer a resolve action.

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, phase exclusions, 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 browse pre-built guideline templates maintained by your organization’s global team. Only enabled guidelines in the Global Tenant catalog appear in the library; disabled global templates are hidden from browse and cannot be adopted.

Click the Library tab at the top of the Guideline Manager page.
Browse or search the available templates.

When library adoption is enabled for your account:

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.

Adopting a guideline also brings in every ontology rule referenced in its rules — initiation, continuation, and matching rules included. You do not need to adopt those ontology rules separately first. If your tenant already has a copy of an ontology rule (for example, because you adopted it earlier from Ontology Manager), that existing copy is reused rather than duplicated. Newly adopted ontology rules appear on the Ontology Rules tab in Ontology Manager, where you can review or customize them.

When library adoption is disabled for your account, you can still browse the library, but Adopt is unavailable. A message at the top of the Library tab explains that adoption requires account configuration. Contact your GEMA administrator if you need adoption enabled.

You can still preview updates to guidelines you already adopted from the library, but applying an update (Adopt Update) is also blocked when library adoption is disabled.

Library adoption, guideline evidence checks, and Describe Rules are configured by GEMA global administrators in Tenant Details; tenant administrators cannot change those settings.