What is considered a formulary drug?

A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.

What is a non formulary drug?

If a medication is “non-formulary,” it means it is not included on the insurance company’s “formulary” or list of covered medications. A medication may not be on the formulary because an alternative is proven to be just as effective and safe but less costly.

What is the purpose of drug formularies?

The primary purpose of the formulary is to encourage the use of safe, effective and most affordable medications. A formulary system is much more than a list of medications approved for use by a managed health care organization.

What are the Tier 1 drugs?

Tier 1 – Generic: All drugs in Tier 1 are generic and have the lowest possible copayment. A copayment is a fixed amount you pay when you get a prescription filled or receive other health care services. Drugs listed as Tier 1 are preferred because they offer the best combination of value and effectiveness.

What is a non-formulary exception?

The non-formulary exception process provides physicians and members with access to non-formulary drugs and facilitates prescription drug coverage of medically necessary, non-formulary drugs as determined by the prescribing practitioner.

Is non-formulary the same as non preferred?

What are non-preferred brand-name drugs? These are brand-name drugs that are not included on the plan’s formulary (list of preferred prescription drugs). Non-preferred brand-name drugs have higher coinsurance than preferred brand-name drugs.

What drugs are not covered by Part D?

Medicare does not cover:

  • Drugs used to treat anorexia, weight loss, or weight gain.
  • Fertility drugs.
  • Drugs used for cosmetic purposes or hair growth.
  • Drugs that are only for the relief of cold or cough symptoms.
  • Drugs used to treat erectile dysfunction.

How are drug formularies developed?

A drug formulary is a list of generic and brand-name prescription drugs covered by a health plan. The health plan generally creates this list by forming a pharmacy and therapeutics committee consisting of pharmacists and physicians from various medical specialties.