The drug formulary provided by your healthcare provider is not a quick read, but way easier than that bedside copy of “War and Peace.”
However, you won’t have to go too deep in the weeds before you see the co-pay levels for your drug – and maybe discover an acceptable alternative that will lower that medical bill.
Generally, you can search your formulary in two ways:
1. By Medical Condition
If you know what condition your drug treats, you can search by category such as “Cardiac Drugs” or “Anti-Inflammatory Agents.”
2. By Alphabetical Listing
If you’re not sure what medical category to look under, simply go to the formulary’s index for a listing by ‘brand name’ or ‘generic.’
Find the page listing your drug; you’ll see the Drug Tier column with numbers ranging from 1 to 5, depending on the extent of your healthcare providers coverage.
A medical brand name drug (Tier 3) costs way more than generics (Tier 1) — generic drugs use the same active ingredients as the brand name, but can only be produced after the brand’s patent has expired.
Preferred drugs (Tier 2) usually run less than brand name drugs used to treat the same condition. Your provider may also offer Non-Preferred Brand Drugs (Tier 4) or Specialty Tier Drugs (Tier 5).
**”My drug isn’t listed!”
If this is the case, call your medical provider’s customer service center. Ask for a list of similar drugs they cover, and present the list to your physician.
No luck? You may have to ask for an ‘exception’ for the right drug and dosages for your medical condition.
Still no luck? You can always make an appeal to your healthcare provider.