My plan states that I have a different amount of coverage for drugs that are on their formulary than for drugs that are not. A formulary is a list of drugs and supplies that your plan covers. Every plan has its own formulary, and plans use their formularies in different ways. Some plans will provide their entire formulary to members when they sign up. Other plans give the formulary only on request.
Some plans post the formulary on the Internet at the plan s Web site.
You can always find out whether a particular drug is on the formulary by calling your plan s customer service representative. Under some plans you may be able to obtain an exception to the formulary and receive coverage for a nonformulary drug if your child s doctor asks your plan to cover it. Your plan should have a special request process that you and your doctor need to follow to obtain an exception to the formulary. The exception process must be in writing and must be given to you when you ask for it. Under Minnesota law, members of fully insured HMO plans have certain rights when it comes to drugs that are not on the formulary.