What is a non-formulary drug?

What is a non-formulary drug?

• A. A drug on the plan's preferred list
• B. A drug approved for over-the-counter use
• C. A drug that is always the lowest price
• D. A drug not on the plan list, often more expensive

Answer: (D)

A non-formulary drug is a medication that isn’t included on a plan’s approved drug list, the formulary. Because it isn’t on that list, it’s usually not covered under standard benefits and may require prior authorization or come with higher out-of-pocket costs. The formulary is arranged to favor drugs that provide good value and proven effectiveness, so drugs on the preferred list are typically covered with lower copays. The other statements describe drugs that are on the plan’s preferred list, over-the-counter status, or simply refer to price, none of which define non-formulary status.

A non-formulary drug is a medication that isn’t included on a plan’s approved drug list, the formulary. Because it isn’t on that list, it’s usually not covered under standard benefits and may require prior authorization or come with higher out-of-pocket costs. The formulary is arranged to favor drugs that provide good value and proven effectiveness, so drugs on the preferred list are typically covered with lower copays. The other statements describe drugs that are on the plan’s preferred list, over-the-counter status, or simply refer to price, none of which define non-formulary status.