Which term refers to the list of prescription medications that a drug plan will pay for?

• A. Drug Formulary
• B. Balance Billing
• C. Concealment
• D. Claim

Answer: (A)

A drug formulary is the list of prescription medications that a drug plan will pay for. Plans create formularies to balance patient access with cost control and ensuring medicines are clinically appropriate. Medications on the formulary are usually organized into tiers, with generics and preferred brands typically costing less for the member, while non-formulary drugs may require higher copays, prior authorization, or alternative covered options. If a needed drug isn’t on the formulary, you can often request an exception or consider a covered alternative. Other terms described here refer to different concepts: balance billing is when a provider bills you for the difference between their charge and what the insurer pays; concealment is hiding information; a claim is a request for payment to the insurer.