Formulary
Insurance Glossary
The list of prescription drugs a health plan covers, arranged in tiers that set what the patient pays for each one. Generic drugs usually sit in the lowest cost tier and specialty drugs in the highest, and some drugs require prior authorization or a documented trial of a cheaper alternative first. Plans can change a formulary during the plan year, and a drug that is not on it is generally not covered unless the plan grants an exception.
This content is for general informational purposes only and is not insurance, legal, or financial advice. Coverage, exclusions, eligibility, and pricing vary by insurer, by policy, and by state, and only the policy documents control what is covered. Always confirm the details of any coverage with a licensed insurance agent or the issuing carrier before you buy.