Difference between formulary and non-formulary RX's?

Question

I got my new insurance card in the mail today. On it, it has a list of what my co-pays are for different services. Office Service, Emergengy Room, Inpatient, etc. In the same list it mentions RX Formulary ($8/$15) and RX Non-Formulary ($25/$25). What does this mean? Is the price difference between generic and name brand? Is one better than the other?

Answer 1

Every insurance company has a big book or drugs that it will cover, called the formulary. The $8 should be the cost for a generic and $15 would be name brand.Any prescription that you would get that isn't in the formulary would cost you $25. Always ask your doctor to check if a prescription is formulary or not, and always ask if a generic is available (by law they're supposed to have the exact same ingredients as the name brand)

Answer 2

Formulary and Non-Formulary generally refer to brand name drugs. A formulary drug is one that is preferred by your insurance while a non-formulary, even though covered, is given a higher copay for you to pay as your insurance prefers you to use another product.

Here is an easy example: Let's say you need an Rx antihistamine and your doctor has recommended either Allegra™ or Zyrtec™. Your insurance may prefer Allegra™ and will charge you the $15 formulary brand copay but if you wanted Zyrtec™ it would be $25.

The only exception to this is when there are non-formulary generics (ones that are usually pretty expensive) and these may cost you the higher $25 copay even though they are generic products.

Answer 3

Every insurance company has their own formulary. Formulary is just a fancy name for a catalogue of medications.
Formulary drugs are the medications made by pharmaceutical companies with which your insurance company has made an agreement, usually to get the medications at a discount. This is done to decrease the costs to the members.
Non-Formulary Drugs are any prescriptions made by a pharmaceutical company with which your insurance company does not have a pricing agreement.
There is no chemical difference in the active ingredients between a generic or non-generic drug. That is the law in the United States, as well as most of the rest of the world. One is not better than the other, they are just made by different companies.
Every hospital also has it's own formulary based on it's agreements with the different pharmaceutical companies, to get better prices and cut costs.
There are so many medications, made by so many pharmaceutical companies, that it isn't really possible, or cost effective, for one hospital or pharmacy to carry them all.
Just look at how many brands of asprin are in the aisle at you local pharmacy, and those are only a few of the total number of companies that make asprin in the U.S.

Answer 4

Formulary Definition

Answer 5

Define Formulary

Answer 6

Formulary simply means the list of drugs that the Pharmacy has plenty of stock of, due to cost savings and/or effectiveness. If you have a non-formulary drug prescription, they may or may not have it available to you immediately. It may have to be special ordered, or they may have a small stock of it. You will almost always pay more for a non-formulary drug, because it is considered non-preferred over the more popular choices.

Answer 7

Insurance companies have a list of meds that they will cover...not sure if its cheaper for them or why...the meds arent really better than one another ...for example they pay for prilosec but not nexium....both which will basically do the same thing....just make sure ur doctor knows ur insurance so he/she can prescribe u formulary drugs and save u $$$$$

Answer 8

the truth about generic drugs are they can by law be +/or/- by 10% in the ingredient of the name brand drug they are copying.

Answer 9

formulary implies it is not as good as the generic