When comparing health plans, it’s essential to understand the medication formulary, a list of covered medications. This list helps keep costs down while ensuring access to safe and effective treatments. A formulary is typically divided into tiers based on cost, with lower tiers having lower out-of-pocket costs.
What is a Formulary?
A formulary, also known as a drug list, is a selection of generic and brand-name prescription medications covered by a health plan. Your insurance will typically help with payment for the medications that appear on this list. Nonformulary medications are those not on the list and may require prior authorization before your health plan will cover them.
Some formulary medications are covered at 100%, meaning you have no cost-sharing. For others, you may have a copay, a fixed amount that you pay, or coinsurance, a percentage of the medication’s cost. The purpose of a formulary is to help you and your prescriber choose medications that are effective, safe, and covered by your insurer, while also keeping costs down.
How to Use a Formulary
When shopping for a new health plan, review the formulary to confirm that the coverage fits both your prescription medication needs and your budget. You can typically find a link for the formulary in the summary of benefits and coverage. If you’re already enrolled in a plan, you can find your formulary on your health insurer’s website or patient portal.
If your medication isn’t on your plan’s formulary, you may be able to request a formulary exception with help from your prescriber. This involves submitting paperwork and a letter of medical necessity that explains why you need the nonformulary medication. Your insurer will review the request and respond, often within a few days.
Original reporting: KEYT (Ventura/Santa Barbara) — read the source article.
