About Formulary
Recently you may have heard about formularies. Formularies have
been used in hospitals for many years. Many health plans utilize
them and most recently some medical groups have started relying
on formularies. What is a formulary, how does it work and how
will it affect you are just some of the questions we would like
to answer for you.
Q:
What is a formulary?
A: Simply
stated, a formulary is a list of medications available to your
health care provider to use in your treatment and covered as
a prescription drug benefit for you. Most hospitals have used
formularies for years to control costs while still providing
quality medications. Health plans and even some large medical
groups have turned to formularies to help put a lid on rising
medication costs.
Q:
Are there different types of formularies?
A:
Basically, there are two types of formularies. An open
formulary is a list of medications from which your health care
provider can prescribe. In addition he or she would also be
able to prescribe medications not on the formulary. A closed
formulary allows your doctor to prescribe from the formulary
list. All other medications (called non-formulary) would not
be covered.
Q:
Why are formularies necessary?
A:
Medication costs continue to rise. Formularies list those
medications which offer the best value without sacrificing quality
of care. Keeping a lid on rising prescription costs help all
of us reduce health care and premium costs.
Q: Who decides which medications are on the
formulary?
A: Medications
are added or deleted from a formulary only after careful review
by a committee of practicing physicians and pharmacists. This
committee, called a pharmacy and therapeutics committee, has
the responsibility of reviewing new and existing medications.
This committee decides which medications provide quality treatment
at the best value.
Q:
How is a medication added or deleted from the formulary?
A: A medication must first demonstrate
safety and effectiveness to be added to a formulary. Only after
this is determined is the cost of the medication considered.
Some medications have similar safety and effectiveness however,
are available at a lower cost. The lower cost medication would
then be placed on the formulary while the higher cost medication
would not.
Q:
How does my health care provider know which drugs are on the
formulary?
A: Health plans
print their formularies yearly. Formulary books are distributed
to your health care provider annually. In addition, all changes
to the formulary are communicated to your doctor on a regular
basis.
Q:
What if my medication is not on the formulary?
A: Formularies usually have listed alternative
medications which often have the same therapeutics action on
your body but, available at a lower cost. If your medication
is not listed on the formulary, ask your doctor or pharmacist
for an alternative. |
