602-381-9900 info@focusbenefits.com

What is this drug formulary thing in the Affordable Care Act?

by Dec 30, 2019

 You never notice some cars until you own one and they seem to be everywhere? Well, you will be hearing about “Drug Formularies” a lot more and then realize they are all over the place. And — you are impacted!

 A drug formulary is a list of drugs your medical plan will agree to pay for if you need a prescription. In the “formulary,” or list, there will be drug categories that might all be similar and come from different drug companies.

Your insurance provider agrees to provide a type of drug (not a brand), and then they decide which drug company provides that treatment at the lowest cost. That means your favorite brand, the one you see on television all the time, might not be included.

Under ACA (Obama Care), drug formularies got more complicated because the “cost” to provide medical care is really the problem, and limiting drug usage and the prescription cost is another place to reduce the overall cost to the system. Note that I said the cost to the “system,” not your cost!

So, in addition to “network size,” “Exclusion lists,” and “if” you will get a subsidy payment, you need to look at the drug formulary for any plan you might consider to provide medical care insurance coverage. It could be a tragedy if you choose a really inexpensive plan and then find out it does not cover for the new DNA based prescription you need.

For more information call Bill Weaver, (602) 381-9900!