Formularies

Most prescription plans have a formulary. A formulary is a list of medications the plan prefers that you use. These medications are typically less expensive for the plan. Medications that are more costly to the plan are also more costly to you. Most formularies use a "tier" system where the lowest tier options are the least expensive for you and the highest tier options are the most expensive to you.  Formularies usually indicate which medications require prior authorization (see below).

Having access to your formulary, and bringing it with you to appointments, helps us choose the best medications you can afford when a prescription is needed. It also saves you (and me) time when a prior authorization is required as it can be done right at your appointment. If we are not aware that a prior authorization is needed, then you won't find out until you try to pick up the medication at the pharmacy. At that point, you either pay out of pocket for the full price, or you wait a few days until I am notified and can complete the prior authorization with your insurance company.

Prior authorization is your insurance company's way of justifying that you actually need the medication prescribed according to their guidelines- and that a less expensive medication won't do the job adequately for you. Each company has different requirements and rules. They also manage prior authorizations differently. It is often quite time consuming to obtain prior authorization for you; and when done outside an office visit, there will be a charge for the time required. This charge is not covered by your insurance company when done outside an office visit. It is to your advantage to bring your formulary to all office visits!

 

Below are some formularies from common plans. These may not be up to date as plans can, and do, change them frequently.

Walmart $4 Formulary  (opens a new window from the Walmart websit listing $4 drugs from Walmart by condition)

Target $4 Drug Finder (opens a  new window from the Target website listing $4 drugs from Target in alphabetical order)

Target $4 Formulary (opens a  new window from the Target website listing $4 drugs from Target by condition treated)

 

Blue Cross Federal

Blue Cross Federal Formulary

 

Blue Cross Blue Shield Montana

BCBS Montana Link to Formularies

 

Pacific Source

Pacific Source Drug Lists

 

Montana Health Coop

Montana Health Coop Drug Lists