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Contact USA:
Toll Free at
1-800-831-3270
Office Hours: Monday -Friday
7:45am - 9pm EST
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Drug Formularies
A drug formulary is a list of prescription drugs that your insurance wants you to use. These may be dispensed through certain
pharmacies.This list is reviewed and changed by health insurance regularly. Drug formularies are often used by health
insurance to help manage drug costs and improve quality of care. Below is a list of the different types of formularies.
1. Open or “voluntary formularies.” These are simple lists of drugs that the insurance company would like providers to
prescribe. Your doctor can prescribe anything and insurance will cover it. An open formulary pays for both formulary
and non-formulary drugs.
2. Closed formularies. In a closed formulary, the insurance company chooses a limited number of drugs that it will cover
and lists them as formulary drugs. Drugs not included on this list are considered non-formulary drugs and are not covered.
If you need a non-formulary drug, you will have to work with your doctor to get an approval from your insurance company.
This is called an exception process. These formularies are not common, but they do exist.
3. Tiered, or “pre-ferred” formularies. All drugs are covered, but thereare three or more different levels
(tiers) of co-pays. For example, ageneric drug might have a $5 co-pay,while a “preferred” brand drug would have a
$20 co-pay, and a“non-preferred” brand drug would have a $35 co-pay. (See Table 2.)
In summary, health insurance isimportant to everyone.
The type ofcoverage you need changes withevery life event. Review the Six“C’s” of Insurance every year and ifyou change
jobs, get a divorce orwhen your child becomes an adult.Take action and organize yourinsurance forms and bills.
Do nottake “no” for an answer when cov-erage of a health care cost isdenied. Remember, you can appealadenial of coverage.
Knowing your health insurance can help you get and keep the best coverage for you and your family
Source: The Cystic Fibrosis Foundation
 Or call Toll Free: 1-800-831-3270 , contact or email us!
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Contact USA:
Toll Free at
1-800-831-3270
Office Hours: Monday -Friday
7:45am - 9pm EST
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