Get April 2009 Detailed 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.