PODCAST: What is a Medication Formulary?


About First Stop Health | Telemedicine

By Eric Bricker MD


Why Are Certain Medications Non-Formulary?

What Are Formulary Tiers and Its Rules?

Formularies Have Many Rules Associated With Them:

1) Prior Authorization – Approval Must Be Given by the Health Insurance Company/PBM Before They Agree to Pay for a Medication.

2) Step Therapy – Certain Less Expensive Generic Medications Have to Be ‘Tried’ First and Fail Before a Doctor Can Prescribe a More Expensive Brand-Name Medication.

3) Mandatory Generics – If a Brand Name Medication Has A Direct Generic Equivalent, Then the Insurance May Only Agree to Pay for the Generic and Not the Brand.

4) Mandatory Mail Order – Certain Chronic Medications That Are Filled for 90 Day Supplies Must Be Filled via Mail Order and Not at the Retail Pharmacy.


PODCAST: https://www.youtube.com/watch?v=kEjDBp9HdBk



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HEALTH ECONOMICS CITE: https://www.r2library.com/Resource/Title/0826102549




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