What is a formulary?

A formulary is a list of drugs that are covered by a health insurance plan. This list is typically created by a pharmacy and therapeutics committee and is used by insurance providers to determine which medicines are covered under their plans. In Delaware, the state insurance department has set standards for all carriers to follow when constructing formularies. The most important of these standards is that formularies must include all FDA approved drugs and treatments that treat the same condition or symptoms. Formularies must also be updated regularly and must be made available to enrollees before they purchase a policy. Formularies can vary from carrier to carrier, so it is important for enrollees to research the formulary options of all plans they are considering. Additionally, if an enrollee needs a medication that is not on the formulary, they may be able to ask their provider to cover it.

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