What Is a Medication Formulary? Why Are Certain Medications Non-Formulary? What Are Formulary Tiers and Its Rules?

This Video Has the Answers.

Today’s Video is a Fundamental of Healthcare Finance That Every Professional Must Understand… and that Most Consumers DO NOT.

The Formulary is the List of Medications That Are Covered by Health Insurance.

Not All Medications Are Covered. The Doctor Does Not Know What Medications Are or Are Not on Their Patients’ Formularies.

However, the Pharmacy Does Via Computer Software That They Use.

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.

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Pharmacy

Welcome to the Tuscaloosa VA Medical Center in Tuscaloosa Alabama. As part of the largest integrated health care delivery system in America, the Tuscaloosa VA Medical Center is committed to ensuring Veterans receive highly integrated and coordinated care and support services. Our main goal is to provide veterans the world-class benefits and services they have earned – and to do so by adhering to the highest standards of compassion, commitment, excellence, professionalism, integrity, accountability, and stewardship.

Tuscaloosa VA Medical Center offers a wide range of pharmacy services to provide you with all of your prescription needs, from education and counseling to medication selection, either at our campus location or through our automated refill line.

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