These are tough times. But thoughtful choices can stretch the dollars you get.
What is a drug formulary?
A drug formulary is a list of brand-name and generic prescription drugs that are approved to be prescribed by a particular health insurance policy, or in a specific health system or hospital. Drug formularies are developed based on the efficacy, safety and cost of the drugs.
A drug formulary also may contain information about dosages, side effects, contraindications and other clinical information. A committee of medical professionals evaluates the drug formulary, and the clinical input and expertise of several doctors who are not committee members is necessary.
Drug formularies can help control costs for health insurers and policyholders. Patients will pay more for drugs that are not on the formulary, sometimes even 100 percent of the drug cost. Most formularies encourage generic substitution.
Drug formulary example
Sam had a fungal infection and his doctor prescribed a medication for it. Sam knew that if the drug wasn’t on his health insurer’s drug formulary, it would cost him more, so he decided to check. Sam logged in to his insurance company’s website as a member. He saw the following drugs on the formulary for fungal infections: fluconazole, griseofulvin microsize, flucytosine, itraconazole, ketoconazole tablets, nystatin oral, terbinafine, or voriconazole. Sam’s doctor had prescribed a drug that was on the list, so Sam filled the prescription.
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