Drug Formulary
Frequently Asked Questions
What is the Drug Formulary?
How are drugs selected for the formulary?
How do I receive benefits as a member with a Drug Formulary?
How will my doctor know to prescribe a Drug Formulary medication?
What is the Drug Formulary?
A formulary is a list of the drugs we cover. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy or through our network mail-order pharmacy service, and other coverage rules are followed.
How are drugs selected for the formulary?
The drugs on the formulary are selected by our Plan with the help of a team of health care providers. We select the prescription therapies believed to be a necessary part of a quality treatment program and both Brand-name drugs and Generic drugs are included on the formulary.
How do I receive benefits as a member with a Drug Formulary?
At a participating pharmacy, your level of benefits is higher when you use a Drug Formulary medication, meaning you will only be responsible for a copay that varies whether you purchase a generic or brand formulary medication. Your benefit for a non-preferred medication will result in a higher copay. A mail order feature is also available for long-term drug purchases.
How will my doctor know to prescribe a Drug Formulary medication?
Have your doctor review the Formulary Guide to determine if your prescription medications are on the Formulary; you may already be taking Drug Formulary medications. If you are, you will only pay your copay for these drugs. If you are prescribed covered drugs that are not on the Drug Formulary, ask your doctor to review your Formulary Pocket Guide to see if another drug on the Formulary, such as a generic equivalent or therapeutic alternative, can be used to treat your condition. If, after discussion with your doctor, he/she does not prescribe a Drug Formulary medication, your covered prescription will be subject to the higher Non-Preferred copay.
