Most managed care plans offer coverage for medically necessary prescription drugs that have been approved by the government, and sometimes also for certain nonprescription drugs and supplies. Generally, some limits apply. Formularies typically do include many brand-name medications. However, they are often designed to encourage doctors to prescribe generic forms of medications that are chemically similar, or identical, to brand-name drugs but are generally less expensive. The copayment usually covers a month's supply of medication, but may cover up to two months' supply or more if the patient must take the drug for an extended period.
Health plans use formularies in a variety of ways.
Some make them very restrictive, including a specified list of drugs and only rarely agreeing to pay for drugs that are not on the list. This flexible approach can work to your benefit if a drug listed on the formulary causes you significant side effects or you don't respond to it as expected. In that case, your doctor should seek approval from the plan to prescribe another drug. Whatever type of formulary your plan has , your doctor should check to make certain that a drug is included before prescribing it for you. If the drug isn't on the formulary, the physician should follow the plan's procedure for obtaining prior authorization to give you the drug.