What Is Formulary Medication?

With cost of prescriptions rising and the need for new drugs always evolving, it's crucial for the health of your wallet to be aware of what your insurance policy will cover. Most policies include a preferred drug list that will receive the most discounts. When it's time for a new prescription, you may want to consider asking your doctor for one that is part of the formulary.

What Is It?

• Formularies are preferred drug lists. They may vary depending on the type of your insurance and should be readily available in your benefit information. Generally, this list of prescriptions extends to specific generic and brand-name medications that have already been approved by the FDA and are considered to be safe. The drugs on your formulary list are usually negotiated between the manufacturer and insurance company for special volume discounts. Some drugs on the formulary may require pre-authorization (often in the case of oral contraceptives) and are subject to change. Be sure to refer back to your specific benefits.

Why Choose a Formulary?

• Quality medication at affordable prices...it may sound like a dream but this is the goal of the formulary along with giving physicians more information about alternative therapy, enhancing cost effectiveness and giving patients more access to information. Most formularies are chosen after being thoroughly reviewed by the insurance carrier and are placed on the preferred drug list because they are important therapeutically and/or are less expensive than other drugs with the same effect.

Generic vs. Brand Name Medication

• Generic drugs have the same therapeutic effect as brand-name drugs and can help to lower your health care expenses. The FDA regulates the safety and quality of these medications and ensures that the active ingredients in generic medication are in the same amounts as the brand-name. For these reasons, the FDA considers generic drugs to be equally effective as brand names. It's imperative to be aware of what your doctor is prescribing for you and to, whenever possible, choose medications that are covered on the formulary.

How Are Formulary Lists Created?

• Insurance carriers select FDA-approved drugs (both brand-name and generic) based on efficacy, safety and value. There are also usually some manufacturer arrangements (negotiated discounts or rebates) with the insurance carrier. Some medications are selected because they are the only available drug to treat a disease and are a substantial therapeutic advance. When there are multiple drugs available to treat a single condition, the insurance companies review the various options for optimal cost-effectiveness. Drugs may be excluded from the formulary if it is deemed ineffective or its safety is called into question in comparison to similar drugs.

Filling Your Prescription

• To make filling your prescriptions a bit simpler, be sure to have a copy of your insurance carrier's formulary plan with you when you visit the doctor. If you've lost your copy, check online or call your insurance company's customer service department (phone number should be on your insurance card) and request to have one mailed directly to you. Also keep in mind that pharmacies don't always deal with all prescription plans. Be sure that you fill your prescriptions at a participating pharmacy to avoid paying higher prices.