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Transcript:  How to read a formulary (drug list) Infographic

 

How to read a formulary (drug list) 

Your formulary will include a table similar to the one below. It’s the key to helping you understand.  

The drug(s) covered by your plan  

The “tier” level or pricing category – drugs in different tiers may have different costs  

Any special rules for a drug that you’ll need to follow, like prior authorization, quantity limit or step therapy 

 

Drug name Drug tier Requirements/limits
Sample_drug 1 MO
SAMPLE_DRUG 4

QL (30 EA per 30 days)  

MO 

 

You’ll notice drug names are either in italics or CAPITAL letters. These mean:  

Italics – generic drugs that generally have lower copays and costs 

CAPITALS – brand-name drugs that generally have higher copays and costs  

Phrases to know:  

MO = mail order 

QL = quantity limit 

EA = each  

Find your prescription drugs 

There are two ways to find drugs in the formulary:  

1. Search by category. For example, omeprazole is listed under “Gastrointestinal agents.” 

2. Search by name in the index. The drugs in this section are listed alphabetically. 

 

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Disclaimers

${company} Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.