What is a formulary?
A prescription drug formulary is a list of drugs that are covered by your medical plan’s prescription benefit. Both the HSA Advantage and Signature plans cover the same medications, but you pay for them differently, as explained in Section 2.
A formulary is used to ensure that you and your family have access to safe, proven and effective medications, while helping to manage costs. Judi Rx develops and manages our formulary.
You will find the formulary here. The formulary:
- Is based on the recommendations of a committee of highly skilled physicians and pharmacists that review drugs regulated by the U.S. Food and Drug Administration (FDA)
- Drugs newly approved by the FDA will not be covered until the committee described above has fully evaluated them.
- Ensures clinical efficacy, safety and balanced with cost considerations
- Subject to change throughout the year
We encourage you to share the formulary with your doctor to help choose covered medications that are right for your care and your budget, as this is a great way to lower your out-of-pocket costs.
Certain medications require approval from Judi Rx before coverage will be provided. Learn more about prior authorizations.
How to read your formulary
Use this guide to help you understand how to read and interpret the formulary.
Formulary example and definitions
Use the definitions below to help you understand the information within each formulary column.
Product description
The first column includes the medication name and other identifying information.
UPPERCASE letters mean it’s a brand-name medication; lowercase letters mean it’s a generic medication.
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 a particular medication – click 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
The third column includes letter codes to indicate special considerations – it contains information only for some medications. A key for these letter codes is included on the formulary. Here are definitions for some of the most common codes:
- HSA Advantage Plan members will pay the same percentage of coinsurance after their deductible is met (full cost of the drug in until then), but choosing lower-cost generics can help you pay less out of pocket.
- Learn more about copays, deductibles and coinsurance to understand how you and the health system share the cost for your healthcare expenses.