What is a formulary? And, why should I care?
for-mu-lar-y (/ˈfôrmyəˌlerē/)
A list of prescription drugs covered by a prescription drug plan or other insurance plan offering prescription drug benefits. Also called a drug list. (https://www.healthcare.gov/glossary/formulary/)
When we talk about coverage in the Mayo Medical Plan (the Plan), we are talking specifically about the Mayo Clinic Pharmaceutical Formulary (the Formulary). If you or your family members use prescription medication, it can make a big difference in how much you have to pay.
The Formulary was developed and is maintained by a group of Mayo Clinic physicians and pharmacists. It is reviewed on a regular basis and changes are published monthly. The Formulary classifies prescription drugs into 5 broad categories and multiple subcategories.
It looks complicated but it's not. The most important thing to remember is that you get your best benefit from the Plan when you use a Tier 1 or Tier 2 medication. There are two ways to quickly find out what Tier a medication is in.
- On the Mayo Clinic intranet, simply type the word “formulary” in the address bar of your internet browser. You should automatically be directed to the online formulary page. You can enter the name of the medication and you will find a listing of the dosage and forms available. You can also search by therapeutic class to view all of the drugs that are similar in their usage.
- On the internet, you can visit www.MayoClinicHealthSolutions.com. They offer an abridged version of the Formulary (in the Forms section) to make it easier to print and take with you to a prescriber appointment. Or, if you log in you can search the entire database, similar to the searching on the Mayo Clinic Intranet.
Once you know what Tier the medication is in, you can review the chart below to see how much your cost will be in 2018.
If you have questions about coverage for a particular medication or the Formulary in general, please contact Customer Service at Mayo Clinic Health Solutions 1-800-635-6671. Or, as always, feel free to comment below.
Above it states: “The Formulary was developed and is maintained by a group of Mayo Clinic physicians and pharmacists. It is reviewed on a regular basis and changes are published monthly. ”
Where are the published changes each month located that we can see? Not happy when I walk up to get my refill and all of a sudden I am informed that the prescription has been changed to a higher tier and now I have a huge co-insurance to pay. Thanks.
John: Thanks for the question. The Mayo Clinic Pharmaceutical Formulary Committee publishes changes on their intranet site (linked in the article). In the left-hand navigation, you can click on Documents/Communications for a list of all of their articles including their newsletter RxTRA CAPSULE which contains the formulary updates. On a side note, if you regularly encounter high prescription costs, you may want to consider using a Health Care Flexible Spending Account for 2018. We will be posting on that topic next week and you can also read more about it in your Open Enrollment guide.
Want to save a few pennies? Check your refills and see if you need any in 2017. If you do, fill your RX and get your 100-day supply (if applicable) and either pay a $10 mail order copay or $10 coinsurance minimum.