Five Things To Know About Your Drug Formulary

​A drug formulary is a list of prescription drugs that your health plan can help you pay for. Generic and brand-name drug lists provide effective medications at the cheapest possible cost.

Here are five things to know about the drug formulary: 

1. How are drug formulary categorized?
Your formulary can be divided based on drug types. You will see the generic, preferred brand, non-preferred brand, and specialty. Drugs in higher tiers will cost more than those in the lower tiers. Insurance companies differ in how they categorize their formularies. A tier 1 drug of a certain company may not be in tier 1 of another insurer. 

2. How is the health plan's formulary created?
Health providers check the medications based on safety, quality, and cost-effectiveness. Updates on drug formulary change every year. 

Sometimes a prescription may be denied coverage by a health plan. For example:

• The drug has available generics.
• A similar drug is found less effective than the other.
• A similar drug costs more than the other but has the same efficacy.

3. What to do if your medication is not on your plan's formulary?
Ask your insurance company about temporary coverage during the exceptions process. These processes may include confirmation from your physician. It's to know if you need the drug prescribed. If your plan still declines, you may ask for an internal appeal to your insurer. The company can conduct a fair review of your appeal.

4. Does your doctor have access to your formulary?
Your formulary is available for your doctor's review at the discretion of your health care plan. Not all do so; here's what you can do.

• You can share your formulary with your physician.
• You may ask about generic alternatives to lessen cost.
• You may find support from your physician if the plan does not support the best medication.

5. What factors should you think about while selecting a health plan?
There are a few things you must consider when choosing a health plan. The cost of premium and coverage of medications. You should review the medications you take and choose a plan that covers them. Also, it is best to pick a plan wherein you can still see your current healthcare provider.

Conclusion
Prescription drugs are costly. You may avoid paying much if you have adequate coverage. A prescription drug plan adds protection and confidence to your health.

At Medicare Simplified KC, we do our best to ensure that our clients are well-protected with affordable and comprehensive policies. We make sure to go the extra mile to help you with your needs. To learn more about how we can help you, please contact our agency at (816) 701-6661 or Click Here to request a free quote.