What Is a Formulary?

A formulary is a list of prescription medications covered by a health insurance or Medicare drug plan (Part D). Formularies categorize medications into different pricing tiers, directly affecting how much you pay for each prescription.

Why formularies matter

• Controls medication costs: Formularies help insurers manage prescription drug expenses, often encouraging patients to choose cost-effective generic medications.
• Guides medication choices: Knowing your plan’s formulary helps you and your healthcare provider select treatments that align with your coverage and budget.
• Impacts coverage decisions: If your medication isn't listed or is on a high-priced tier, you may pay more out-of-pocket or need to request an exception from your plan.

How Solace can help

A Solace advocate can review your formulary to confirm whether your medications are covered, identify lower-cost alternatives, and help you request exceptions or appeals if necessary. They can also assist in coordinating with your healthcare provider to select treatments that align with your coverage.

What to do next

Unsure if your medications are covered or want to explore more affordable options? A Solace advocate can help you navigate your formulary and medication coverage choices. Find an advocate today.