Treat formulary submissions like version control — not Excel comparison
This prototype demonstrates how formulary submission management can move from Excel comparison and manual SOPs to structured version control, approval workflow, release management, and artifact governance.
The real opportunity
The problem is not “use AI to compare Excel files faster.” Formularies are
structured business, clinical, and regulatory logic — essentially code. They
deserve controlled change sets, reviewable diffs, approvals, locked releases,
and hashed artifacts with a full audit trail.
Suggested demo flow
- Open Formularies — see the parent baseline and its more-generous child.
- Open the child and read the not-eligible-for-submission warning.
- Go to Generate Submission, pick the child — the system blocks it.
- Pick the parent — a hashed artifact is generated and recorded.
- Open the change set and review the exact before/after diff.
- Approve, then merge — the change lands on the baseline.
- Check Artifacts and history: who changed what, why, when, and who approved it.
What this proves
- Formularies are structured data, not files.
- Changes are managed as controlled change sets.
- Every change has a before/after diff, requester, reason, approval, and merge history.
- Parent (CMS-submitted) formularies are distinct from derived/child formularies.
- Derived formularies are more generous to members and must not be independently submitted to HPMS.
- The system blocks or clearly warns when a child formulary is selected for HPMS submission.
- Submission files are generated only from approved/locked parent formularies.
- Every artifact has a version label, timestamp, source formulary, and hash.
The mental model
How proven software-delivery discipline maps onto formulary operations.
| Technology concept | HPMS formulary equivalent |
|---|---|
| Repository | Official formulary baseline |
| Branch | Proposed change set or derived formulary |
| Pull Request | Formal formulary change request |
| Diff | Exact before/after tier, PA, ST, QL, coverage changes |
| Reviewer | Clinical, regulatory, operations, client approval |
| Merge | Approved change added to official formulary |
| Build | HPMS submission file generated from approved data |
| Release | Locked HPMS submission package |
| Artifact | Exact file submitted to CMS |
| History | Audit trail of who changed what, when, why, and who approved it |
The goal is not to make business users use GitHub.
The goal is to bring GitHub-like control discipline into formulary operations
using business language:
DraftCompareReviewApproveLockGenerateSubmitAudit