Getting To Know Your Formulary

I’m just going to say it, health insurance companies can be incredibly frustrating! There are so many different health insurance companies and they all have different policies, requirements, and coverage. 

While it can be frustrating at times, at least for me, I am very grateful to have insurance. Without turning this post into a debate or argument, I wanted to talk about something that is very important for everyone to know about their specific policies - the medication/drug formulary.

What is a drug formulary for asthma?

A formulary is a list of medicines, both brand name and generic that your insurance covers. There are generally different tiers of coverage as far as what the copayment/out of pocket cost will be to you. The generic options are (obviously) the cheapest and it goes up from there. If your insurance doesn’t cover a particular medication, they will offer an alternative with the same mechanism of action.

Request a copy for your drug formulary annually

New asthma mediations are released all the time and prices also can change. It is a good idea to request a copy of your insurance company’s formulary every year to see if there have been any changes made to coverage. Some insurances will automatically send a copy but others require you to request it. They are also usually found online for quick reference.

Bring it to your asthma specialist or pulmonologist

Whether you are anticipating a medication change or not, it is a good idea to have a copy of your formulary with you when you go to any doctor's appointments. Give your doctor some grace when they recommend a particular medication as they might not immediately know if it is on your particular insurance's formulary. You could give them a copy of your formulary to add to your chart for future reference.

If you are prescribed a medication that isn’t on your formulary, ask your doctor if they can write a letter of medical necessity to see if they will make an exception for you. It might not be approved, but it's worth a shot. Your doctor can also work with you and your formulary to find medications to help keep your asthma under control.

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