Formularies are used as a cost effective method of providing prescription drugs to members. Each formulary has been approved by a health vendor's panel of physicians and pharmacists. Formularies enhance the quality of medical and psychiatric care by identifying the best medicines from among the thousands of drugs now available on the market. Formularies are a tool to help resist the skyrocketing costs of prescription drugs. However, the formulary drugs are not selected based on cost alone.
Formularies consist of both brand and generic drugs.
Even though formularies are designed to be comprehensive, you may require a specific drug that is not on your plan's formulary. Your physician may request coverage for the non-formulary drug from your health vendor. Prior authorization of a non-formulary drug is required for you to have coverage through your plan. You should call your health vendor's member services to confirm whether or not a certain drug is on their formulary. When you refill a prescription, be sure the drug is still on the formulary, as these formularies are continually updated, and a drug that has been part of a formulary may not continue to be included.