A drug formulary is a comprehensive list of covered prescription drugs. As new drugs come on the market, they are reviewed and selected for the formulary based on published scientific evidence, relative effectiveness, safety, and health outcomes. The formulary is then updated to reflect any additions or deletions, as well as changes in prescribing recommendations. RegenceCare notifies our providers of these changes on a regular basis. Drugs are selected for the formulary based on published scientific evidence.
Cost is considered only when several drugs have similar clinical data.
In short, cost is never the primary consideration. A committee of local physicians and clinical pharmacists selects prescription drugs included in the formulary. It is important to remember that Regence BlueShield and RegenceCare staff have no vote in deciding which drugs are added to or deleted from the formulary. In such cases, your provider will work with RegenceCare to obtain the necessary approvals. If RegenceCare has a record of covering the non-formulary drug, the pharmacist can simply call RegenceCare to adjust the copay.