What is a drug formulary?
A formulary is a list of effective, affordable and commonly prescribed medications, comprised of brand name and generic drugs. Your plan may feature a formulary to encourage members to use quality, affordable prescription medications. If the plan does include a formulary, the member may pay a lower copayment when the physician prescribes formulary drugs. Some pharmacy plans may limit coverage to drugs on the formulary. The complete drug formulary is usually quite long and technical. UniCare distributes a Formulary Selection Guide that lists commonly prescribed drugs on the formulary. Members who wish to keep their out-of-pocket costs at a minimum should share this guide with their physicians and encourage their doctors to prescribe generic or formulary brand name drugs (if no generic version exists) whenever possible.
So many insurance companies today limit their cardholders to specific drugs that are listed on their list of preferred medication. This list is referred to as the insurance company’s formulary. The formulary started as a hospital based idea to cut cost by only stocking 1 to 2 drugs from each category of medications. It has spread to the insurance companies now due to cost saving measures that insurance companies have developed to cut their overall medication costs. Most companies will provide full coverage on formulary products, but will penalize the insured on non-formulary products by making them pay extra fees or the difference in the cost of the prescribed drug and the formulary drug. In most cases the insurance company will override these extra costs if the insured and their physician can show that the particular medication is needed. Formularies are usually very restrictive, but they do help a great deal in cotrolling costs. • What is Hepatitis and how do you get it? Hepatitis is
