A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1999.
Speak with a licensed insurance agent 866-553-3223
Speak with a licensed insurance agent 866-553-3223
A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1999.
Featured
Will you receive an ACA premium subsidy?
See if you're eligible for the Affordable Care Act's premium tax credits (premium subsidies), how subsidies are calculated, and why they are more robust through 2025.
Featured
Federal poverty guidelines for 2025
The federal poverty level (FPL) - also referred to as the federal poverty guidelines – is used to determine eligibility for Medicaid and CHIP, and for premium subsidies and cost-sharing reductions in the health insurance marketplace.

formulary

infographic regarding formularies

What is a formulary?

A formulary is a list of all the drugs covered by a health insurance plan. Health plans have different formularies, which means that a particular drug might be covered by one plan in your area, but not by another. Rebates from drug manufacturers to health plans' pharmacy benefits managers can also affect which drugs end up on the formulary and into which drug tier they're placed.

However, the ACA imposed some minimum standards on all new individual and small-group plans in an effort to ensure that their formularies are robust and non-discriminatory:
  • The formularies must include at least one drug in every United States Pharmacopeia (USP) category and class, OR the same number of drugs in each USP category and class as the state's Essential Health Benefits benchmark plan.
  • And since 2017, the formulary creation process has been required to be guided by the recommendations of a pharmacy and therapeutics committee.

Get your free quote now through licensed agency partners!

sticky-bottom-cta
close
image image

Discuss your coverage needs with our agency partners.

Call 866-553-3223