A list of prescription medications, approved by healthcare providers or institutions, that outlines the drugs covered by a particular healthcare plan, insurance policy, or healthcare facility. The formulary often categorizes medications based on their clinical efficacy, cost, and availability.
Medications that are marketed under a specific trademark or brand name by a pharmaceutical company. These drugs may appear on a drug formulary, but they are typically more expensive compared to generic alternatives.
Pharmaceuticals that contain the same active ingredients as brand-name drugs but are sold under their chemical or generic names. Generic drugs are often less expensive and are commonly included in drug formularies as cost-effective alternatives.
A classification system within a drug formulary that categorizes medications into different tiers or levels based on their cost or clinical effectiveness. Typically, lower-tier drugs have lower copayments, while higher-tier drugs may require higher copayments or prior authorization.
A process required by some insurance plans or healthcare providers where approval must be obtained before certain medications can be dispensed or procedures can be performed. This process ensures appropriate use of medications and may be necessary for drugs not included in the standard drug formulary.
Medications that are not included in a drug formulary and therefore may not be covered by insurance or healthcare plans. Formulary exclusions are often made based on factors such as cost, clinical effectiveness, or the availability of alternative treatments.
A cost-saving strategy used by some insurance plans where patients must try and fail on lower-cost medications before more expensive or specialized drugs are approved for coverage. Step therapy aims to promote the use of less expensive treatments when appropriate.
Drugs that are used to treat complex or chronic conditions such as cancer, autoimmune disorders, or rare diseases. Specialty medications may require special handling, administration, or monitoring and may be subject to different coverage criteria within a drug formulary.
A process used by healthcare providers, insurers, or pharmacy benefit managers to assess the appropriate use of medications within a drug formulary. DUR may involve evaluating drug interactions, duplications in therapy, or adherence to clinical guidelines.
A subset of medications within a drug formulary that are considered preferred or recommended by a healthcare plan or institution. Preferred drugs typically have lower copayments or fewer restrictions compared to non-preferred alternatives.