Eight Things to Know About Health Insurance Plan Formularies

In my last post, I discussed explained the basics about health insurance company formularies. Here are eight things to remember about formularies:

1. Health care insurance providers develop drug formularies to meet the health needs of the vast majority of its plan members, but no single formulary includes every drug that is needed for every patient.
2. Health insurance providers are required to notify their members when they make changes to their formularies.
3. Differences in formularies comprise a significant difference between health insurance plans; some plans offer more drugs than others do.
4. Some health insurance companies are able to negotiate better prices for drugs than other companies are, passing the savings along to plan members.
5. If your prescription drug is not on your health insurance provider’s formulary, you can ask your doctor to prescribe a similar drug that is covered by your health insurance plan.
6. You can also ask your doctor to see if your plan’s formulary includes brand name drugs with lower co-payments or generic drugs that are suitable replacements for your current prescription drugs.
7. Your doctor can advise you on the possibility of splitting higher dosage pills to save money.
8. You can seek an exception to a formulary if your drug is not on the formulary and no suitable substitute works for you.

Remember, if you have any questions about your health insurance plan or its formulary, feel free to email or call me.