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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.
An exception procedure can be used by prescribers and patients to request coverage for drugs that are not included on a plan's drug formulary. Through this administrative process, a plan can agree to cover medically necessary nonformulary drugs on a case-by-case basis.
Meaning. Non-formulary/Non-covered. Non-Formulary Drugs are not covered on the formulary drug list. An exception may be requested and is subject to review by the plan and is based on Pharmacy policy. Prior Authorization.
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits.
The most commonly prescribed classes of non-formulary drugs were immunobiologicals (vaccines), antiemetics, vitamins, psychotropic drugs, beta blockers, and systemic antimycotics and antibacterials.