Prescription Drug Formulary
Prescription Drug List
A drug formulary is a list of the prescription drugs that your health insurance company has agreed to cover so that when you fill your prescription, you don’t pay the full price of the medication. In most cases, formularies are comprised of drugs that are the safest, most effective and most affordable.
The health insurance company determines what these drugs will cost its customers. In most cases, the health insurance company covers a greater portion of the cost of more affordable drugs, such as generics and inexpensive brand name drugs, giving customers an incentive to opt for these over more expensive options.
Drug formularies are comprised of drug tiers. Some health insurance companies only divide their formularies into two tiers while others may have as many as five or six. The tier that your medication is in determines your portion of the drug cost.
In most cases, each tier is associated with a specific co-pay, and the lower the tier, the smaller your co-pay. For example, your health insurance company may cover almost all the cost of a generic medication that is on the first tier, but you may pay a significant portion of the cost of a third- or fourth-tier drug.
