A prescription drug formulary is the list of medications a health plan covers, along with the coverage rules and cost-sharing that may apply. Drug lists may have tiers, prior authorization, step therapy, quantity limits, or other requirements.
Review the exact plan's formulary
Do not rely only on an insurer's general drug search. Confirm the full plan name and year, then check the relevant formulary. A medication may be covered under one plan but not another, or its cost-sharing may differ.
Questions to ask
- Is the exact medication and dosage listed?
- What tier and cost-sharing apply?
- Does the plan require prior authorization or step therapy?
- Are there preferred pharmacies or specialty pharmacy requirements?
- Can the formulary change during the coverage year under applicable rules?
If a medication is important to ongoing care, verify coverage before selecting a plan and check directly with the insurer when in doubt. This article is educational and does not provide medical advice.