What is a formulary?

Most health plans cover prescription medicines through a preferred drug list. The list of drugs is often referred as a formulary. Getting prescriptions filled that are on your health plan’s drug formulary will help you save money on your generic and name brand medicines. The formulary should include common drugs for most health conditions.

Formularies change

  • When your doctor prescribes you a new medicine, you should check with your health plan to see if the drug is on your plan’s formulary.
  • Your health plan can add or change drugs on the formulary at any time, without informing you first.
  • Generic drugs may replace brand name drugs. This might not impact your treatment, but the pills might look different. However, the drugs will have the same benefits.

Cost

There can be significant cost differences to you between medicines that are covered through your plan and those that aren’t. Some plan formularies also have different cost levels, so that you pay less for some drugs than you do for others. Some drugs might not even show up on the formulary, resulting in higher costs than you originally expected.

Usually generic drugs cost less than name brand drugs. You should check with your doctor or health plan to see if you can replace a name brand drug with a generic version. This might save you some money.

If you change plans:

  • If you happen to change health plans, you should check with your new plan’s formulary to see if your drugs are covered.
  • Even if they are still covered, you might find that a drug you use costs more on your new health plan.
  • You should talk to your doctor to see if there are other drug choices for your condition if your medicine isn’t covered or the cost is out of your budget.

To view your plan’s formulary:

Call your health plan or go to your plan’s website and search for “formulary.” You should be able to search for it through the plan's website.