is a list of prescription drugs that are approved for use within a specific health plan. Formularies categorize drugs into different tiers or levels, often referred to as ‘tiers.’ Each tier has a different level of coverage and cost-sharing
like copayments, coinsurance, or deductibles. Drugs in the lower tiers generally have lower out-of-pocket cost, while those in higher tiers may require higher cost-sharing or may require specific
authorization. Formularies are regularly updated by adding and removing medications and their tier placement may change over time. Patients, healthcare providers, and pharmacists can consult the formulary to determine if a particular medication is covered, identify alternative options, or understand the cost associated with specific drugs.
Where do I find my formulary?
- Your SBC should mention a website or the formulary name (i.e. MedicineRx)
- Search “[Insurance Company] Formulary” in your preferred search engine.
- Call your insurance company – they can look up a medication on your behalf.
How to search in a formulary:
Once you find your formulary, find your prescribed or potential medication.
There will be a legend to ensure you understand the symbols.
Here is an example of a legend. Consult your insurance carrier to learn more about your formulary.
It is important to note that formularies vary between healthcare systems or insurance plans, andindividual patient needs and preferences should also be taken into account when making treatmentdecisions.