What is a drug formulary?

A drug formulary is a list of prescription drugs—both generic and brand name—that are preferred by your health plan. Often health plans will only pay for medications included on this list, unless your healthcare provider consults with your health plan to get approval for a drug that is not listed.

A committee of nurses, doctors and pharmacists recommend drugs for a health plan’s formulary and most health plans pay for drugs that have been approved by the Food and Drug Administration but it’s important to note that in most cases you will pay a share of the cost as part of your copayment or coinsurance.

Many health plans place different drugs into different “tiers” on their formularies. Drugs in each tier have a different cost, with drugs in a lower tier generally costing less than those in a higher tier.

Keep in mind that formulary lists vary by health plan, so it is important that you know which medications are included on your specific health plan’s formulary. You can find details on your health plan’s formulary and an explanation of their copayment tiers in the materials that you receive from your health plan when you enroll. Most plans will send out an updated list each year. You may also find information on formularies on your health plan’s website.

People who need medications for a chronic condition should consider shopping around for a health plan with a formulary that covers the medications they need, if possible.