What is the Drug Formulary?

The terms "Formulary Drug List", "Preferred Drug List" and "Select Drug List" are health program labels with similar meanings. The Food and Drug Administration (FDA) has compiled a list of medications (approximately 7,000) that your carrier may categorize as Formulary or Preferred. These drugs are recognized as safe and effective and are considered cost-effective. A Formulary Drug list also helps guide physicians and pharmacists to select the medication that provides the appropriate treatment for the best price. Its purpose is to optimize patient care through rational selection and use of drugs and to ensure quality plus cost-effective prescribing.

The Formulary Drug list is unique to each health plan and is subject to change. The most recent formulary list is available on a carrier's website for member and provider reference. Medications may be added to the Preferred Drug list or to the Formulary Exclusions List at any time. The list of medications may be dispensed in both retail and mail-order pharmacies.

Your health care provider can utilize the Formulary for your health care needs, while helping you get the most out of your prescription drug benefit.

Formulary categories

Carriers categorize medications by generic, brand (or formulary), or non-formulary also known as "tiers". Some Rx plans have Tier 1 copay while others have two or even three tier copays and still others may even have a deductible. Typically, the category descriptions are as follows:

  • Tier 1 (lowest copay): Generic medications listed on the Preferred Drug List.
  • Tier 2 (middle copay): Brand name medications listed on the Preferred Drug List.
  • Tier 3: Covered generic and brand-name medications not listed on the Preferred Drug List.