Health Care Reform: Recent News & Events

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Changes to Prescription Drug Formularies: Generic Drugs - Tuesday, August 16, 2016
If you are keeping up with the news, you have seen the costs of some drugs skyrocket recently. With that in mind, please be advised that insurance carriers are making changes to their prescription drug formularies that could impact the coverage they provide for prescription drugs, including generic drugs.
What is a prescription drug formulary?
A prescription drug formulary is a list of the prescription medications covered by an insurance carrier, or health plan. Health plans typically decide what prescription drugs to cover on their formularies based on plan-sponsored reviews of the medical efficacy, safety, and cost-effectiveness of particular drugs.
Why do health plans use formularies?
Prescription drug formularies are a way for health insurance plans to control costs and encourage the use of lower cost medications. Formulary design often encourages the use of generic medications, which cost less than the equivalent name-brand medications. Health plans also use formularies to encourage the use of lower-cost brand drugs over higher-cost brand drugs with similar effectiveness, and to discourage the use of less effective drugs.
Recently we are seeing that health plans are changing their formularies and are no longer providing coverage for some previously covered generic medications. Why is this? In some cases, there may be several generic drugs on the market that treat the same condition. Because the prices for these generics can vary widely, the insurance carrier may now only cover the lower cost generics.
As a result, we encourage you to confirm with your health plan that prescription drugs, even generics, will be covered before you have prescriptions filled.  
Have further questions? Need assistance determining if your health plan covers your prescription drugs?
Please contact us. We're here to help.

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