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.

Related FAQs

What is a minimum essential coverage?
What is a coinsurance clause?
What is an out-of-pocket minimum?
What is a pre-existing condition?
What is a catastrophic health insurance plan?
What is an exclusion clause?
What is an out-of-network provider?
What types of health insurance are available?
What is a Dependent Care Assistance Program (DCAP)?
What is an employer shared responsibility payment?

What is a formulary?

Related FAQs

Related Blog Posts