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Difference between formulary and non-formulary RX's? |
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? 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) 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. 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 $$$$$ Every insurance company has their own formulary. Formulary is just a fancy name for a catalogue of medications. 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. |
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