For many people, the medications they take on a daily basis are critical to keeping them healthy and saving their lives.
Being able to be prescribed these medications at a low cost is necessary, and it’s something patients deserve, especially when these patients have chosen to pay for a particular health insurance plan expecting it to provide the medications they need.
That’s why drug formularies are so important to understand.
What Is A Drug Formulary?
A drug formulary is a list of prescription drugs, including both brand name and generic, which are covered by a health insurance plan. Most insurance plans covering prescription medication have a drug formulary.
Some formularies have different “tiers,” in which certain drugs are placed at different cost levels. A drug on a lower tier tends to cost less than a drug on a higher tier. The drug formulary establishes which drugs are going to be accessible and most affordable for doctors to prescribe. If a drug is not on a formulary, the patient will very likely have more out-of-pocket costs in order to be able to take the medication their doctor recommends.
Understanding what medications are listed on various health plans’ drug formularies is very important for individuals who have chronic illnesses that require specific treatments. If you’re a patient who relies on specific medications to stay healthy and active, you’ll want to make sure you request to see these formularies and review them before you ever make a decision regarding which health plan to purchase.
Not everyone knows to do that, however, and it’s very important that we spread the word!
Formularies aren’t just important for people already taking medication to treat pre-existing conditions. Understanding the formulary of your health insurance plan (or one that you’re considering purchasing) ensures you know what medications would be available should you develop a particular condition, whether it be related to diabetes, cancer, asthma, or even certain skin conditions.
The Dangers of Negative Mid-Year Formulary Changes
Unfortunately, right now, NYS law does not prevent formularies from changing halfway through the plan year. This means, while you might have committed to an insurance plan, it’s not necessarily committed to providing you with the medications it originally agreed to cover when you purchased the plan, should you need them.
These formulary changes could make you lose access to a medication you need, or make it more expensive for you to get it. You could suffer out-of-pocket costs or the side effects of having to switch to a different medication.
That’s why we support legislation to prevent negative mid-year formulary changes. You can help us! Find out how by visiting: http://nyhealthworks.com/access/