Why a Medication Formulary is Your Best Friend

How many of us can relate to the following scenario: we make a visit to our doctor and are prescribed a new medication that sounds very promising. One that just might finally make a difference in our breathing. Maybe it’s a new, cutting edge medication or simply one that we haven’t tried before. Either way, we’re excited to try it out. Anything to be able to breathe. We patiently (or not so patiently) wait in line at our local pharmacy for our turn at the pick up counter only to find out...

...it’s not a covered medication with your specific health insurance plan.

Utter devastation, frustration and downright anger set in. The astronomical out-of-pocket retail cost of medications makes it virtually impossible to purchase them without insurance coverage. And often times, even with insurance coverage the out of pocket copays are too high.

Insurances are a tangled web to navigate and I think we can all agree they can be incredibly frustrating to figure out. Especially when determining what is covered and what isn’t. It can take time and so much energy to sort it all out and just when we finally start to make sense of it all the year is up and things change all over again.

Last year my little family and I moved across the country from the West Coast to the Midwest. Prior to moving I had had the same health insurance for well over a decade and had become very familiar with what medications it did and didn’t cover, etc. I was terrified of the thought of having to start all over with a completely new insurance once I found a new Respiratory Therapist job, not to mention having to build a new medical team for myself and learn the new medication formulary for my new health insurance.

So what is a Formulary?

A medication formulary is basically a (often very large) list of the medications that your specific insurance plan covers. There are usually different tiers within the formulary that start with the cheaper options (usually the generic versions of the medications) and then go up from there to the ones that have the more expensive copays.

What I did was I called my insurance company directly and requested a copy of the formulary and brought it with me to my next doctors appointment to share it with my doctor. Often times doctors have so many patients with so many different insurances and they can’t keep it straight who has what insurance nor which insurances cover which medications. It is so much easier when you have that list handy at the appointment. If you aren’t able to obtain a formulary from your medical insurance company, don’t be afraid to ask your doctor's office to do that bit of legwork for you to see if the medication they want to prescribe for you is covered BEFORE they write that prescription. It will save you the headache and frustration.

Don’t forget to request a new copy of your insurance’s formulary annually as coverage may change and you won’t want to encounter any surprises when picking up those prescriptions that are so necessary to keep us all breathing!