What is a formulary exclusion list?
What is a formulary exclusion list?
Some payer and provider groups say they interfere with patient access to medicines. Formulary exclusions — a decision by a PBM not to include a drug on its list of covered drugs, called a formulary — are not new, but they are increasingly in the spotlight, partly because the PBM industry is increasingly consolidated.
What is a formulary guide?
A formulary is a list of generic and brand name prescription drugs covered by your health plan. Your health plan may only help you pay for the drugs listed on its formulary.
How would you explain a formulary exclusion to your patient?
A formulary exclusion list includes the drugs that an insurer, health plan, or pharmacy benefits manager (PBM) does not cover. Proponents of drug formulary exclusion lists say they quell costs by having patients use lower cost drugs. Ideally, patients should be using drugs that are the best value for their cost.
What is a plan exclusion?
An exclusion is a provision within an insurance policy that eliminates coverage for certain acts, property, types of damage or locations. Things that are excluded are not covered by the plan, and excluded costs don’t count towards the plan’s total out-of-pocket maximum.
What is hospital formulary?
The formulary system is a method by which physicians and pharmacists, working through a Pharmacy and Therapeutics Committee of the medical staff, evaluate and select medications for use in a hospital. …
What is the open formulary?
An open formulary is where all drugs on an approved drug list are covered. A closed formulary is where some drugs on an approved drug list are covered; you choose the access level. With a closed formulary you get primarily generic medications: Maximum amount of cost savings.
What are typical exclusions in an insurance policy?
A standard homeowners insurance policy contains exclusions, or causes of loss that aren’t covered. Policy exclusions include earthquakes, flooding, or property that is damaged due to poor maintenance.
What is the Geisinger gold standard RX formulary?
What is the Geisinger Gold Standard Rx Formulary? A formulary is a list of covered drugs selected by our plan in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment
What if I Have Questions about my Geisinger Health Plan?
Geisinger Health Plan and Geisinger Choice. We encourage you to contact our Pharmacy Customer Service Team if you have any questions about this information or the type of benefit in which you are enrolled. Also, please refer to your benefit documents, as formulary exclusions may differ based on the specific benefit.
Which prescription medication benefits does Geisinger offer?
General Formulary Information This formulary is applicable to the Triple Choice and Traditional Prescription Medication Benefit plans offered by Geisinger Health Plan, Geisinger Choice PPO and Geisinger Health Options. We offer two main prescription medication benefits: the “Triple Choice benefit” and the “Traditional benefit.”
How do I contact Geisinger pharmacy customer service?
Pharmacy Customer Service Team Contact Information Telephone: (800) 988-4861 or (570)-271-5673; TDD/TTY 711 Fax: 570-271-5610 Mailing address: Geisinger Health Plan Pharmacy Department Internal Mail Code 32-45 100 North Academy Avenue Danville, PA 17822 Tiers
