A well-developed formulary enhances quality of patient care by encouraging physicians to prescribe medications that are safe, effective and likely to achieve the best possible outcome for the patient.
A multitiered effort
Formularies usually have what’s known as tiers, or levels that represent a member’s cost for different types of drugs.
- Lower tiers include medications that are generic
- Higher tiers are either brand-name medications or specialty drugs, which are highly expensive medications for treating rare conditions
Several factors are considered when assigning medications to tiers:
- Availability of a generic equivalent
- Total cost of the medication
- Cost of the medication relative to other medications that fall in the same therapeutic class (they treat some of the same conditions)
- Availability of over-the-counter alternatives
- Clinical and economic factors
It’s all about the formulary
A formulary outlines the medications that are covered by your plan. Covered drugs costs and restrictions vary by plan.
A medication formulary is a continually updated list of prescription medications. It represents the medications currently covered based upon the clinical judgment of the Geisinger Health Plan Pharmacy and Therapeutics Committee, which is made up of pharmacists and physicians.
The committee thoroughly reviews medical literature to:
- Determine which medications are likely to produce the best results for patients
- If two or more medications produce the same clinical results, elements like cost and ease of use are considered
Learn more about Geisinger Health Plan.