How does the Formulary work?
Formulary Questions
How does Formulary work?
What is a formulary?
Should I use generic drugs?
What is a 3-tier benefit?
What if my drug is not listed on this formulary?
Participating pharmacists and physicians drive formulary compliance, as illustrated below:

Pharmacist:  Network pharmacists are alerted to formulary dispensing opportunities on-line at the POS. If a formulary drug is available, the pharmacist calls the physician to consult with him or her about changing the prescription to the preferred medication.

Physician:  Physicians are supplied with a printed copy of the formulary. Physicians consult this formulary when prescribing medications. If, for some reason, a physician prescribes a non-formulary drug, the dispensing pharmacist will contact the physician to consult with him or her on changing to a formulary medication.

When a member presents a prescription at a participating pharmacy, the pharmacist is informed through the on-line system if the prescribed drug is on the formulary. If it is, the prescription is filled and dispensed. If it is not, the pharmacist makes a reasonable effort to contact the prescribing physician to request that the formulary alternative be used.

If the physician approves using a formulary alternative, the pharmacist dispenses the formulary drug. If the physician cannot be reached or does not approve the formulary alternative, the pharmacist dispenses the prescription as originally written.
What is a formulary?
A formulary is a list of prescription medications selected by a committee of physicians and pharmacists. The committee chooses the formulary products using strict criteria such as safety and efficacy. As there may be more than one brand name drug available for your medical condition, it is suggested that when appropriate, you ask your physician to prescribe a preferred brand name product (2nd tier) if a generic medication is not available.
Should I use generic drugs?
Generic drugs are cost effective alternatives to brand medications. Choosing a generic product will usually result in lower co-pays. Ask your physician to authorize generic substitution whenever a generic equivalent is available.
What is a 3-tier benefit?
(Refer to your group benefits to determine whether this applies to you.)
Medications in a 3-tier benefit structure are divided into 3 groups. Generic drugs are in the 1st tier (lowest co-pay). Preferred brand drugs are in the 2nd tier (middle co-pay) and non-preferred brand drugs are in the 3rd tier (highest co-pay).
Note: Brand drugs, which have a generic equivalent fall into the 3rd tier while their generic equivalent will be available in the 1st tier.
What if my drug is not listed on this formulary?
This is a partial formulary listing of the most commonly prescribed drugs within the categories listed. If your drug is not listed it may well be that:
  1. Your drug is generic and as all generics are considered formulary it would be covered.
  2. Your drug is not a formulary medication and is either not covered or may be available at the highest co-pay.
  3. Your drug is not listed but may be covered.
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