Do you ever wonder why some prescription drugs
are covered by your prescription drug plan and some are not? Why can't you get any drug your
doctor orders? Who makes these decisions and why? Everyone has seen in the news that
prescription drug costs continue to rise. A prescription drug formulary, or more commonly
just formulary, is one way to manage that cost.
A formulary is a list of prescription drugs, both
generic and brand name, that your prescription drug plan has approved as covered drugs. Under a
formulary, the prescription drug plan reviews all drugs for safety, effectiveness and their ability
to provide cost-effective treatment to you. You probably know someone who has high blood
pressure. Did you know that there are over 30 medications on the market used to help lower
blood pressure? Should the prescription drug plan cover all of them if they all have
the same outcome? Let's compare two drugs, Drug A and Drug B.
Drug A and Drug B are both
approved to lower blood pressure but Drug B costs four times as much as Drug A. Drug A is
taken twice a day and Drug B is taken once a day. Both are equally effective in lowering blood
pressure. Is it worth paying four times as much for the convenience of taking a pill
once a day compared with twice a day? The prescription drug plan decides that Drug A will be
covered under the formulary, but Drug B will not. Formularies are not always about
covering just low-cost drugs, it's about understanding that the
prescription drug plan considers safety, effectiveness, and which drug has
the most value to your health. For lower out-of-pocket costs, you and your
doctor should choose generic medications or preferred medications on the prescription drug
plan's formulary. If you have more questions on your formulary, contact your prescription drug
plan the number is on the back of your ID card.
