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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.
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 benchmark plan.
  • And starting in 2017, the formulary creation must also be guided by the recommendations of a pharmacy and therapeutics committee.

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