Drug formulary

Definition

A drug formulary is a list of prescription medications that are approved for use and covered by a particular health insurance plan or hospital. It includes information on the proper usage, dosage, and restrictions of the drugs listed.

5 Must Know Facts For Your Next Test

1. Drug formularies help ensure patients receive effective and cost-efficient medications.
2. Formularies are often divided into tiers, with different co-pays based on the tier of the medication.
3. A Pharmacy and Therapeutics (P&T) committee typically oversees and updates the formulary list.
4. Access to non-formulary drugs may require special approval or prior authorization.
5. Formularies can vary significantly between different insurance plans or healthcare providers.

Review Questions

• What is the main purpose of a drug formulary?
• Who typically oversees and updates a drug formulary?
• What might be required to access a medication not listed on the formulary?

Related terms

Pharmacy Benefit Manager (PBM): An entity that manages prescription drug benefits on behalf of health insurers.

Prior Authorization: A requirement that a physician obtain approval from a health plan before prescribing a specific medication.

Tiered Formulary: A system where medications are categorized into different levels based on cost-sharing requirements.