AMCP dossiers and unsolicited-request packets, cited and label-checked, ready before the P&T deadline
Every payer request answered with a cited, label-checked packet in days, ahead of the P&T deadline.
See one case, screen by screen ↓Formulary season puts 14 P&T meetings into ten weeks, and each packet is due 14 days before its meeting. A new indication has just been approved, so the AMCP dossier is under revision just as plans ask for it. Every request has to be shown to be unsolicited, every ask checked against the current label, and every packet approved by medical and by regulatory and legal review before it goes out.
Most of the time goes on assembly, not judgement. Someone splits the payer’s letter into asks, checks the account was not contacted first, finds which dossier sections a new label or study touches, retypes values from forest plots and tables, presets the budget impact model to the plan’s membership and writes a cover letter. An adolescent question slipped into a packet, or a value that differs between an abstract and a figure, is exactly what MLR sends back.
Estimated median days per stage, by hand and with the solution, as shown on its dashboard.
Six specialist agents take in each request, map and read the evidence, draft, check and assemble the packet; the dossier owner decides.
Crestline Health Plan’s P&T Committee reviews ulcerative colitis therapies on November 12, and Veltrimab’s ulcerative colitis indication was approved on September 30. Here is what happens to their request, screen by screen, in the working solution.
Priya opens the solution to 8 open payer requests, 3 packets due within two weeks and 14 P&T meetings ahead, four of them at accounts that have not asked for a dossier. The Veltrimab v6.0 edition stands at 7 of 17 sections done, with sign-off targeted for October 24. The P&T calendar shows every meeting by account type, from national PBMs to Medicaid.
“Each bar is the packet window — due 14 days before the meeting.”
Dr. Hannah Brooks, PharmD, clinical pharmacist on Crestline’s P&T Committee, writes through the eDossier portal for a 1.4M-life plan. The agent highlights her four asks in her own words and records the unsolicited check: it came in unprompted, she decides on formulary, and the last company contact was August 14. Her request for updates for 12 months is recorded too.
Packet due Oct 29 · 36 days to P&T.
Three asks are on label: the dossier with ulcerative colitis, a budget model for the membership, and results after a failed advanced therapy — 17.9% vs 4.2% clinical remission at week 12 in VLT-301, read from the Figure 2 forest plot and confirmed by the text. The adolescent question is not: label §8.4 says safety and effectiveness in pediatric patients with ulcerative colitis have not been established. Priya hands it to Dana Okafor in Medical Information, reply due October 9.
“This ask stays out of the packet; Medical Information answers it separately and records it.”
v6.0 is under revision, so Priya chooses: send v6.0 with ulcerative colitis, since sign-off on October 24 comes before the October 29 deadline, or v5.2 now with v6.0 to follow. She picks v6.0 and presses Build packet. The agents map the asks to the dossier, preset the budget model to 1.4M members and draft the cover letter, each step shown as it runs.
The cover letter answers A1–A3 one by one and lists the 14 sections changed since v5.2. The Approved Product Dossier v6.0 runs to 17 sections and 112 pages. The Excel budget impact model is preset to Crestline — year 1 $522k (+$0.031 per member per month), year 3 $1.46M (+$0.087) — with every input left editable. A 3-page §3.2B excerpt answers the subgroup question.
“Payer deck left out. Crestline did not ask for slides, the deck stays with Sam Patel for the account meeting.”
Priya sends the packet to MLR — which the solution allows only once the adolescent ask has been handed to Medical Information. Omar Haddad approves for medical review and Lena Ortiz for regulatory and legal review, both on October 7 at 09:14. The packet now reads 2 of 2 approved.
Priya sends the packet through the eDossier portal. The unsolicited record, the packet and both approvals are filed with REQ-2417. The rest of the packet goes now; the v6.0 dossier is released to the portal the moment it is signed.
“Standing request: updates may go to this account until Oct 2027.”
The UC approval touched 14 sections, the VLT-302 52-week results 4, the psoriasis 5-year extension 2 and the new list price 3. In §2.1B Product information the agents add the UC indication, 600 mg IV induction at weeks 0, 4 and 8, then 200 mg subcutaneous from week 16 and every 8 weeks after, the hepatotoxicity warning during UC induction, and the WAC from January 1, 2027. Each change shows its reason and can be reverted; unchanged text stays word for word.
“Each change shows why — click the reason to see its source.”
Three values in the §3.2B evidence table come from figures, each confirmed by a table or a sentence. One is not settled: the VLT-302 abstract gives week-52 endoscopic improvement as 50.1%, while Figure 3 and Table S4 give 50.2% (136 of 271). The reader recommends Table S4 because it holds the patient counts; the dossier owner decides and the choice goes into the change log.
No value from a figure without a confirming table or sentence.
23 requests answered, a median of 2.4 days from received to sent, 87% passed MLR the first time and every packet before its P&T deadline. The dashboard shows what payers ask for — full dossiers 46%, budget or cost models 22% — where the days go by stage, and recent P&T decisions for accounts that received a packet.
The same request, seen by the five people who carry it — what their week looked like, and what it looks like now.
Six specialist agents take in each request, map and read the evidence, draft, check and assemble the packet; the dossier owner decides.
Reads each payer request from the portal, email or an account director, splits it into numbered asks and records why it counts as unsolicited — channel, requester role and any company contact in the 30 days before — plus any standing request for updates.
Maps every source to AMCP Format 5.0 sections and, when a label, study or price memo changes, finds each section it touches and keeps the change log against the last published edition.
Reads values from tables, forest plots, bar charts and Kaplan–Meier curves, with confidence interval, page and figure number, and checks each against the text or the source table.
Drafts each changed AMCP section with a citation on every value, keeping still-correct text word for word so the redline stays small, in plain, non-promotional language.
Classifies every claim and every payer ask as consistent with the label, health-care economic information on an approved indication, pre-approval information or an unapproved use, citing the label passage behind the call.
Assembles the tailored packet — cover letter with what changed, the dossier, the budget model preset to the plan’s membership — and derives payer decks from the signed dossier, a section citation on every slide.
Decides; MLR approves. The agents propose; a named person decides.
Anyone on the team can ask about a dossier, a payer request or a source — or tell it what to change. Every answer is cited.
Which P&T meetings need the UC update first?
In order of packet deadline, Keystone Rx is due first and gets v5.2 with a note that v6.0 follows. Crestline can have v6.0 — sign-off on Oct 24 is before its Oct 29 deadline. Riverbend and St. Anselm meet in November but have not asked, so nothing goes to them.
What changed between v5.2 and v6.0?
14 of 17 sections changed, for four reasons: ulcerative colitis approved, the VLT-302 52-week results, 5-year psoriasis data and the new list price. §4.2B waits for the UC cost-effectiveness report.
Why is the adolescent question going to Medical Information?
Because it is an unapproved use. The label says the safety and effectiveness of Veltrimab in pediatric patients with ulcerative colitis have not been established. Crestline asked about it unprompted, so Medical Information answers it separately, factually and on the record — it never goes in the dossier packet.
Add a rule: hold any packet that includes material the payer did not ask for
Added and switched on. The packet builder now lists each file against the ask it answers and holds anything that answers none. It already applies to Crestline — the payer deck stays out.
13 screens from the working solution, on its sample data. Pick one to see it large.
Who approves, which rules the agents follow and how packets go out are settings, not a project.
| Setting | Default | Choose from |
|---|---|---|
| Packet deadline | 14 days before each P&T meeting | Any number of days · drives the calendar and the clocks |
| Medical review | Omar Haddad | Any person on the team |
| Regulatory & legal review | Lena Ortiz | Any person on the team · keeps the unsolicited record |
| Budget and cost models | Dr. Maya Chen | Any person on the team · §4.1B–§4.3B and every preset model |
| Unapproved-use questions | Dana Okafor | Any person on the team · answered outside the packet |
| Sending packets | Priya Raman, after both MLR approvals | Any person on the team |
| Budget model format | Excel workbook, inputs unlocked | Excel workbook, inputs unlocked · Web calculator link |
| Rules the agents follow | 7 on, 2 required | Switch on or off · describe a new rule in plain words |
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
“demo” = seen in the working solution, on its sample products and accounts · “target” = the design goal, measured in the live solution · “estimated” = our estimate, as shown on the solution’s dashboard · Sources: AMCP Format for Formulary Submissions 5.0 (2024). People, products and accounts named on this page are characters in the working solution.
A formulary submission built to the AMCP Format for Formulary Submissions — executive summary, product information, clinical evidence, economic value and modelling, supporting evidence and appendices — that payers and P&T committees use to review a product. The Formulary Dossier Builder keeps those sections current with a citation on every value and builds a tailored packet when a payer asks.
The request intake agent splits each request into asks and records why it is unsolicited: the channel, the requester’s formulary role and that there was no company contact in the 30 days before. Nothing is built until that check passes, and updated dossiers go only to accounts with a standing request for a stated period.
The label and claims checker classifies every ask against the current prescribing information and cites the passage behind the call. An unapproved use is handed to Medical Information, answered separately and recorded; it never goes in the packet.
The evidence mapper finds every section the new label, study or price memo touches, and the section writer redrafts only what changed, keeping the rest word for word. Each change shows its reason and source, can be reverted, and the section is signed by its owner before the edition is published with a change appendix.
Yes. The table and figure reader reads values from tables, forest plots, bar charts and Kaplan–Meier curves, with page and figure number. It uses a value from a figure only when a table or the text confirms it, and puts any disagreement between sources to a person.
Yes. The packet builder presets the model to the plan’s membership and leaves every input editable in the Excel workbook the payer receives; a web calculator link is the other option in Settings.
Yes. The dossier owner decides which edition goes and what is in the packet, section owners sign their sections, and nothing is sent until medical review and regulatory and legal review have both approved. Every agent step and every decision is on the request’s activity trail.
The Agentic Solution Engine builds and deploys it from your requirements — your current dossier, your evidence library, your MLR roles and a sample of past payer requests — and it goes live once every quality gate has passed. We will walk you through it on your own dossier first.
A global value dossier drafted section by section, with every sentence linked to its source and checked against the label.
1-min filmRebate ValidationEvery rebate invoice line checked against the contract, and every dispute backed by its clause.
1-min filmPayer ContractsEvery payer contract and amendment becomes cited terms in force, with every deadline on a clock.
1-min filmWe’ll run the Formulary Dossier Builder on your own dossier and a sample of past payer requests.