Formulary

A formulary is a list of prescription drugs covered by a health insurance plan, typically categorized into tiers based on cost and coverage criteria. Insurance companies and pharmacy benefit managers use formularies to determine which medications are covered, and at what cost, for their members. Drugs on the formulary may be subject to copayments, coinsurance, or other cost-sharing requirements specified by the insurance plan. Formularies often encourage the use of generic or preferred brand-name drugs over non-preferred or specialty medications to control costs. Healthcare providers and patients can consult the formulary to understand coverage limitations, find alternative medications, or request exceptions when necessary. Understanding the formulary is essential for patients to make informed decisions about their prescription drug coverage and manage medication costs effectively.