Are All Drug Formularies the Same?

No. And the difference between them can result in thousands of dollars in costs.

When crafting a drug formulary, every individual health insurance provider will use its own committee of pharmacists and physicians to determine what drugs are covered and how much they will cost. This variety leads to each health provider’s drug formulary being unique.

Some difference that you may run across would be:

  • The number of tiers listed will be different, and may range from 3 – 7 in quantity.
  • The vocabulary or names for each tier may vary between formularies. Some may simply list the number of the tier, while others may use words to identify each tier, like “Preferred Drugs,” “Non-Preferred Generic” or “Specialty Drugs”
  • The drugs classified on one formulary as a certain tier may be listed within a more expensive or cheaper tier on another formulary.
  • Certain restrictions (step therapy, prior authorization, quantity limits) found on one formulary may be absent from another.

Because drug formularies can vary dramatically from plan to plan and from insurer to insurer, it is important that you understand the formulary attached to your current plan. And take what you learn to compare potential health plans fully before choosing next year’s plan to ensure that is best for you.

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