What is a formulary?

A formulary is a list of prescription drugs that are covered by a health insurance plan. This list is created by a team of healthcare professionals and typically includes all of the approved medicines to treat a specific medical condition. In Virginia, formularies are regulated by the Virginia State Corporation Commission and must be reviewed and updated annually. The formulary is designed to help people find the best and most cost-effective drug options available under their health plan. It outlines the type of drugs the plan pays for and any restrictions that may be placed on certain drugs, such as quantity limits or prior authorization requirements. Additionally, formularies are often tiered, with generic medications being less expensive than brand-name drugs. Generally, health plans require members to use drugs from the formulary in order to receive coverage; however, in some cases, coverage for off-formulary drugs may be available.

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