What's a Formulary

A Formulary is an easy reference guide of brand name and generic drugs that are covered by a plan. The list is created to ensure that members of a plan receive high quality, cost-effective, and safe drug therapy. CMS guidelines ensure that all formularies are similar, however each plan’s formulary may not include the exact same medications. But they will have therapeutically equivalent medications and all Part D plans are required to cover certain drug classes.

Using generic drugs will generally provide the greatest savings. Also, most of the prices for medications covered by a plan's formulary are discounted. Now you are able to review and compare each plan's formulary.

Plans include both brand name and generics in their formulary. Some plans may have a more extensive list of covered drugs on their formulary then others.

Review your current prescriptions and a plan’s formulary when choosing a plan. Talk with your doctor to ensure that your prescriptions are covered on the formulary. If they are not, you can ask your doctor to switch you to an equivalent drug that is covered in order to save you money. You can also save money by talking with your doctor to see if there is a generic available for your prescription.

No formulary can meet the unique needs of everyone. Your doctor can request an exception to the formulary when it is determined that no other medication will work for your needs.

View RxAmerica's Part D Formularies

Formulary decisions are made by an independent Pharmacy & Therapeutics Advisory Panel. The formulary is reviewed regularly and revised to incorporate new advances in medications. For instance, when medical research finds new treatments or when a new drug is approved by the FDA. In addition, generic versions of brand name drugs may be added to a plan’s formulary when they become available.

Plan providers contract with many different pharmacies from small independents to large national chains and mail-order. They negotiate special rates and discounts with the pharmacies in order to save you money. Usually you will need to use a pharmacy in the plan’s network in order to fill your prescriptions, so check with the plan to see if your local pharmacy is in the plan.

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Out-of-Network coverage

Plans will have systems in place to help alert your pharmacy to potentially harmful drug interactions. The system provides your pharmacist with an instant alert or warning when you go to fill your prescription. This helps protect you even when you fill your prescriptions at different pharmacies in the plan’s network.