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San Fernando Health Insurance

What is Drug Formulary?

A formulary is a list of prescription drugs that a health insurance carrier has approved for use by the members of each health insurance plan. Each health insurance carrier and each health insurance plan has its own formulary. All formularies are similar, but they may not include exactly the same drugs.

Health insurance carriers and health insurance plans offer 3 types of drugs:

Generic

  • Generic drugs are lower-cost alternatives to brand name drugs and are have the same exact chemical composition
  • You can save money by switching to a generic version

Formulary

  • Formulary drugs are the preferred drugs of a carrier or health insurance plan and are usually brand name drugs
  • Health insurance plan formularies may include both generic drugs and brand name drugs

Non-formulary

  • Non-formulary drugs are the non-preferred drugs of a carrier or health insurance plan and are usually brand name drugs

9 Things to Know About Drugs, Formularies and Cost Saving

  1. Formularies are designed to meet the needs of most people, however, no formulary can meet everyone’s needs.
  2. Formularies will not change very often, but when they do, you will be notified.
  3. Some carriers may offer a broader formulary than others do.
  4. Carriers may also have different cost sharing for a particular drug.
  5. One carrier may be able to negotiate special prices with drug companies and pass the savings on to the plan members.
  6. Your doctor can help you switch your prescriptions to drugs that are covered by your plan.
  7. Your doctor can also help you lower your costs by switching your drugs to lower co-payments or generics.
  8. Talk to your doctor about buying a higher dosage and pill splitting which will save you money.
  9. A formulary exceptions process is available if your doctor determines that no substitute drug works for you.

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