How to use your health plans formulary

Most health plans will usually have a committee of practicing physicians and pharmacists who recommend drugs for their formulary based on quality, safety and effectiveness. How to use your health plans formulary can be frustrating at times so let's take a better look at how to use a formulary and a few other important things about them.

What is a formulary?
Basically, a formulary is a list of medications that your insurance company will help you pay for. The list can be changed from time to time by the insurance company. The list of drugs can also be generic brands as well as name brands and have been approved by your health plan and will only pay for medications that have been approved and on their list unless prior approval is given.

How do formulary's work?
The first thing you need to know is that you will be responsible to pay a share of the cost of the prescription. This is known as a co-payment. Your co-payment amount will depend on what tier your drug is in on your health plan's formulary. Let's take a closer look:


• Tier 1 drugs have the lowest co-payment and will generally include medications


•  Tier 2 drugs have a lower co-payment and will include brand name medications


•  Tier 3 drugs have the highest co-payments and will include non-preferred brand name medications.

Being informed
As you begin to use and understand your health plans formulary you need to talk with your provider about which tier you fall under and about prescribing generic drugs or name brand drugs. Sometimes things get mixed up and a provider can prescribe a medication that is not on your formulary which your health plan may not cover if it's not approved. It this happens you will be responsible for paying the entire cost of the medicine. Not be caught uninformed about your formulary. Take time to talk with your provider and go over the list of approved medications, hospitals, doctors, etc. before you just go out on your own.

Learning the rules
Health plan formularies have certain and specific rules that you have to follow. If you don't follow the "rules" so to speak, you could end up with a huge bill that you will have to pay regardless of why. For most health plans their rules fall into the falling categories:


• Doctors and hospitals- formularies will generally give you a list of approved doctors and hospitals that accept their insurance coverage. If you don't see the name of the hospital then make sure you ask your provider before you make an appointment.


•  Specialists- Many health plans won't allow you to see specialists unless your physician has deemed it necessary.


•  Medicines- Your drug formulary is the list of prescriptions and medicines that are approved by your health plan.

Understanding and learning how to use your health plans formulary can make a huge difference in how much you end up pay for medicines as well as doctors visits. If you don't read your formulary list carefully you could wind up with a lot less money in the bank than you expected so take the time to understand how it works. Talk with your provider and make certain on what is approved and what isn't.

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