How Do Drug Formularies Work?

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.