What Is a Formulary?

A formulary is a list of prescription medications covered by a health insurance or Medicare drug plan (Part D). Formularies categorize medications into different pricing tiers, directly affecting how much you pay for each prescription.

Why formularies matter

• Controls medication costs: Formularies help insurers manage prescription drug expenses, often encouraging patients to choose cost-effective generic medications.
• Guides medication choices: Knowing your plan’s formulary helps you and your healthcare provider select treatments that align with your coverage and budget.
• Impacts coverage decisions: If your medication isn't listed or is on a high-priced tier, you may pay more out-of-pocket or need to request an exception from your plan.

How Solace can help

A Solace advocate can review your formulary to confirm whether your medications are covered, identify lower-cost alternatives, and help you request exceptions or appeals if necessary. They can also assist in coordinating with your healthcare provider to select treatments that align with your coverage.