Methods, systems and computer program products alert pharmacies of formulary alternatives. A claim generated by a provider and including at least one drug is received, where the claim is directed to a payer recipient. The claim is reviewed to identify the at least one drug. The at least one drug is then compared to a pre-established formulary alternative table, which may be created or managed, at least in part, by the payer recipient. A preferred drug alternative may then be forwarded to the provider when the at least one drug has a match in the pre-established formulary alternative table.