Formulary

A "Formulary" is a list of prescription drugs that are approved to be prescribed under a particular health insurance policy or within a specific healthcare system. Formularies are developed and maintained by a committee of pharmacists and physicians, who evaluate drugs based on their efficacy, safety, and cost-effectiveness. The purpose of a formulary is to encourage the use of medications that provide the best overall value and clinical outcomes for patients.

Key aspects of a formulary include:

1. Tiered Structure: Many formularies are organized into tiers, which categorize drugs based on their cost and whether they are generic or brand-name. Drugs in lower tiers generally cost less for the patient than those in higher tiers.
2. Preferred Drugs: Formularies often list preferred drugs, which are medications that are recommended within a certain class of drugs due to their effectiveness and cost efficiency. Non-preferred drugs may be available but could come with higher out-of-pocket costs for the patient.
3. Prior Authorization: Some drugs on a formulary may require prior authorization before they are covered. This means the prescriber must provide justification for the specific medication choice, demonstrating that it is medically necessary for the patient's condition.
4. Step Therapy: Formularies may implement step therapy protocols, where patients are required to try one or more specified drugs first (usually starting with the most cost-effective option) before a more expensive drug is approved for coverage.
5. Exclusions: Certain medications may be excluded from a formulary if they are deemed not cost-effective or if there are suitable therapeutic alternatives available at a lower cost.

Formularies play a crucial role in managing healthcare costs while ensuring that patients have access to effective medications. They are a key component of prescription drug plans in both public healthcare systems and private health insurance policies, guiding the prescribing practices of healthcare providers and the medication coverage available to patients.