What is a Drug Formulary?
A formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. This list is also called a drug list. Medications not on a plan’s formulary are generally not covered. A formulary applies to Medicare AdvantageMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). Prescription Drug Plans (MA-PDA Medicare Advantage plan that offers Medicare prescription drug coverage (Part D), Part A, and Part B benefits in one plan.) and stand-alone Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plans.
In some cases, coverage restrictions may apply. Coverage restrictions, or formulary restrictions, are placed on certain drugs to limit their use. Prior authorizationPrior authorization is a process used by health plans to control healthcare costs. Most HMO plans and some PPO plans require authorization before receiving certain treatments, medical services, or prescription drugs., quantity limits, and step therapy are all examples of coverage restrictions.