How to read your prescription drug formulary

A formulary helps you understand what medications are covered by your pharmacy benefit and how much you will pay for those medications, as well as special considerations for some medications. Use this guide to help you understand your pharmacy benefit’s formulary.


Formulary example and definitions

Use the definitions below to help you understand the information within each formulary column.

 

 

Showing an image of an example of how to read your forumary

Product description/drug name

The first column includes the medication name as well as other identifying information. UPPERCASE letters indicate brand-name medications and lowercase letters indicate generic medications. Medications are listed in alphabetical order within their category.

It is helpful to know your medication’s active ingredient or generic name. Then you can search the formulary for the medication by clicking the magnifying glass in the PDF toolbar or type CTRL+F to open the “Find” feature.

 

Tier

The second column includes number or letter codes to indicate medication cost tiers.

    • Tier 1 = Primarily generic medications, which are the most cost-effective option for many disease states. Generic drugs must work in the same way and provide the same clinical benefit as their brand-name counterparts to be approved by the Food and Drug Administration (FDA).
    • Tier 2 = Includes lower-cost brand name medications and some higher-cost generics.
    • Tier 3 = Contains higher-cost brand-name medications, often with lower-cost brand or generic alternatives that provide the same clinical benefit.
    • Tier 4 = The most expensive non-specialty brand-name medications, typically with lower-cost alternatives that provide the same clinical benefit.
    • 50% = 50% coinsurance is required for this medication, regardless of your medical plan.
    • OC = This is an oral chemotherapy medication.

Limits and restrictions/special codes

The third column includes letter codes to indicate special considerations for some medications. A key for these letter codes is included at the bottom of every formulary page, but here are definitions for some of the most common codes:

 

Image of how to read formulary special codes
  • Tiers do not affect HSA Advantage Plan coinsurance percentages but choosing lower-cost generics vs. higher-cost brands can affect coinsurance 
  • Learn more about copays, deductible and coinsurance in our guide to understanding how you and the health system share the cost for your healthcare expenses.
  • If you know your medication’s brand name, you can check for a generic equivalent. Click the magnifying glass in the PDF toolbar or type CTRL+F to open the “Find” feature. The search results will reveal any available generics.