Definition
A list of prescription drugs covered by your health insurance plan, organized into tiers. Tier 1 (generic) drugs have the lowest copays, while Tier 4 (specialty) drugs are the most expensive. Drugs not on the formulary may not be covered at all, or may require prior authorization.
Related Terms
- Generic Drug
A prescription medication that contains the same active ingredient as a brand-na...
- Specialty Drug
High-cost medications used to treat complex chronic conditions such as cancer, r...
- Step Therapy
An insurance requirement that you try less expensive medications before the insu...
- Deductible
The amount you must pay out of pocket for covered healthcare services before you...
- Copay
A fixed amount you pay for a covered healthcare service after you have met your ...
Understanding healthcare terminology helps you communicate more effectively with providers and make informed decisions about your care. Use our procedure cost database to find fair prices for any medical service.