        |
 Home > FAQs   
What is a "drug formulary"?
Question - What is a "drug formulary"? Answer - A drug formulary is a continually updated list of prescription medications that represent the current clinical judgement of providers and experts in the diagnosis and treatment of disease. The medications listed in the formulary are those that are routinely available as part of your prescription drug benefit plan. Formularies have been in use for many years and are most commonly used by hospitals, health plans, HMOs, government agencies (including the Veterans Health Administration, Department of Defense, and many state Medicaid programs), and self-insured employers.
Question - Why use a drug formulary? Answer - A drug formulary supports our goal of providing plan members with safe, effective, high-quality, cost-effective medications to ensure the best medical results. Formularies support other tools that promote quality and optimal results such as drug utilization review and medical treatment guidelines.
Question - What drugs are included in the formulary? Answer - The drug formulary includes both brand-name and generic medications, produced or marketed by many manufacturers. Because many conditions may be treated with a wide selection of both old and new drugs, it is important to carefully select those drugs that we will include in our drug formulary. We know that formulary decisions have an impact on all components of the health care delivery system. Studies show that choice of the most appropriate drug results in fewer treatment failures, reduced hospitalizations, better patient adherence to the treatment plan, and fewer side effects. This help to keep overall medical costs down, improves access to more affordable care, and provides plan members with an improved quality of life.
Question - Who decides what drugs are included in the formulary? Answer - Decisions on which drugs are included or excluded from formulary are made by a Pharmacy and Therapeutics (P&T) Advisory panel. The Panel is comprised of physicians and pharmacists representing a broad-based scope of clinical practice. The Panel meets regularly to review not only individual drugs, but also selected categories of medications. This is done to ensure the formulary remains up to date with current medical practices.
Question - Does the drug formulary cover "Generic" drugs? Answer - The formulary includes both brand-name and FDA-approved generic equivalents. We encourage the use of generic products, when available, with a few exceptions. Since 1970, the FDA has approved and monitored almost 9,000 generic drugs. These generics adhere to the same strict guidelines and inspections for quality, effectiveness and safety that the FDA requires of brand name medications. Not all generic drugs, however, are on the formulary, just as all brand-name drugs are not on the formulary.
Question - What if the drug I have prescribed is not listed in the drug formulary? Answer - Because the formulary is broad-based and includes a variety of drugs in nearly all therapeutic categories, the majority of patients will utilize drugs that are listed on the formulary. If it is medially appropriate, please consider a medication listed in the formulary that is therapeutically equivalent to one you have prescribed.
Question - What happens if I do not judge that there is a therapeutically equivalent medication on the formulary and still want to prescribe the non-formlary drug? Answer - For quality assurance purposes, all of our plan members have access to non-formulary drugs, when medically necessary. In certain cases, a physician may be required to obtain pre-approval from the member's health plan. Some members may have access to non-formulary drugs without having to have prior-authorization. For these members, the patient may have to pay a higher out-of-pocket (copayment) amount. |
     |
