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Committee of physicians and pharmacists. The formulary includes drugs that are commonly prescribed by physicians, clinically useful, and cost-effective. Bring this Member Formulary to your doctor appointments. Your doctor can review the formulary and determine if a drug listed is appropriate for you. When you have a prescription filled, your copayment will be at one of three levels or "tiers." Tier 1 and tier 2 drugs will be the lower copayments. However, a tier 1 or tier 2 drug may not always.

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A formulary is a list of generic and brand name prescription drugs covered by your health plan. Non-formulary drugs typically only include brand-name medications and come with high out-of-pocket expenses. Your health plan may only help you pay for the drugs listed on its formulary.

First, understand that your health plan isn't saying you can't have the drug your healthcare provider prescribed. Instead, excluding a drug from its formulary is more like saying that it won't pay for that particular drug. You may still have it if you or someone else pays for it.

A drug list – also called a formulary – lists your health plan's preferred medicines. You'll usually pay less when you choose a drug that's on the list. Our search tools make it easy to see if your prescriptions are on the list. You can also find alternatives that may save you money.

“Often, drugs are excluded because their competitors are willing to negotiate a lower overall cost for their product. In addition, PBMs developed Real Time Benefit Tools to provide physicians and other prescribers the ability to check, ahead of and during a patient's visit, eligibility and formulary information.”

Plans can change their formularies at any time. Your plan may notify you of any formulary changes that affect drugs you're taking.

A formulary exclusion list includes the drugs that an insurer, health plan, or pharmacy benefits manager (PBM) does not cover. Proponents of drug formulary exclusion lists say they quell costs by having patients use lower cost drugs. Ideally, patients should be using drugs that are the best value for their cost.

If a medication is “non-formulary,” it means it is not included on the insurance company's “formulary” or list of covered medications. A medication may not be on the formulary because an alternative is proven to be just as effective and safe but less costly.

Often, a drug appears on a formulary — the list of medications covered by an insurance plan — but then gets dropped. This can happen if a medication is seldom used, there is a generic available, or a more affordable option exists.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232