Drug Formularies are lists of medications covered by the insurance company. Not all drugs are covered.
A drug formulary is the list of medications covered by the insurance company. It should be noted that not all drugs are covered -
- OTC (Over the counter) medications are not covered and require the individual to pay cash out of pocket. Tylenol is a good example.
- Select brand medication are often not included (the insurance companies cover some brands, but not all)
- Cosmetic Drugs - non formulary
Rules for Formularies -
There are tiers within a formulary... Tiers of Co-Pays. What does this mean? Basically, as the Tier goes up, the out of pocket expense also goes up.
- Tier 1 medications (least expensive)
- Tier 4 medications (most expensive)
- Some require prior authorization (permission from the insurance company) before consuming.
How Do I find out which prescriptions are on the formulary?
- Go to the insurance company's website
- Look for "Formulary"
- You can search the name of the drug and see if it is on your formulary, and then what tier it is listed.