Overview
During a client conversation, you can ask Gia whether a specific medication is covered under your client's plan — and get the full picture: drug tier, prior authorization requirements, quantity limits, and step therapy restrictions. Gia looks this up from the plan's formulary document on file, so you get an answer specific to your client's actual plan rather than a generic lookup.
How to Check Formulary Coverage
1. Open Ask Gia and select your client
Go to Ask Gia in the left navigation. Click Select a client in the input bar and choose the client whose plan you want to check. Gia uses that client's enrolled plan — and the formulary document on file for that plan — as context.
2. Ask about the medication
Use the drug's brand or generic name. You don't need to know the specific formulation — Gia will return coverage details for all available dosage forms:
"Is my client's Metformin covered, and does it require prior authorization?"
"What tier is Eliquis on this plan, and are there any restrictions?"
"Is Synthroid covered? What's the copay?"
"Does this plan cover Humira, or is there a step therapy requirement?"
3. Review Gia's response
Gia returns a coverage summary for each dosage form and strength on the formulary — including tier, PA status, and quantity limits per fill.
Understanding the Response
Depending on the drug and plan formulary, Gia's response may include some or all of the following details:
Tier — determines your client's cost-share. Lower tiers generally mean lower copays. Your client's plan documents show the copay for each tier.
Prior Authorization (PA) — if required, the prescribing physician must get approval before the plan covers the drug. No PA means it fills without pre-approval.
Quantity Limit (QL) — caps how many units can be dispensed per fill (for example, 150 tablets per 30 days). Exceeding the limit may require a PA exception from the prescriber.
Step Therapy (ST) — if noted, the plan requires trying a lower-tier drug first before covering this one.
In-network pharmacy — Gia may include the client's on-file preferred pharmacy. Prescriptions must generally be filled at a plan network pharmacy for coverage to apply.
Things to Keep in Mind
Formulary availability depends on what's on file. Gia can only look up a drug if the plan's formulary document is available in GydeOS. If it isn't, Gia will say so.
Verify if the drug isn't in the client's profile. If Gia notes that the medication isn't listed in the client's medication history, confirm with the client or their prescriber before passing the information along.
Works for both Medicare and ACA plans. Gia can check formulary coverage for Medicare Advantage and ACA plans when a formulary document is on file in GydeOS.