A formulary is a list of drugs and supplies covered by a health insurance plan, and each plan has its own specific formulary. Non-formulary drugs are those that are not covered or that are covered a higher rate than formulary drugs. A plan with an “open formulary” may allow coverage for a drug not listed on the formulary, while a “closed formulary” will not.
Formularies are generally created by physicians and pharmacists from different medical specialties. These individuals review new and current drugs and then select drugs for a formulary based on a variety of factors, including patient demographics, the safety of the drug in question, and cost. Medications that are not approved by the Food and Drug Administration (FDA) are non-formulary.
There are often alternative drugs that can be prescribed in place of a drug that is non-formulary on a plan. Patients who encounter this issue should talk to their doctor for an alternate drug or have their pharmacist contact the doctor.
Drug coverage is a big consideration for many people when choosing a health insurance plan. An expert insurance agent can assist you in finding a health insurance plan that best suits your prescription coverage needs. Benefit Packages has more than 20 years experience helping people find California health insurance. Call us today for a quote.
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