What does non-formulary prescription drug mean?
Drugs that are usually considered non-formulary are ones that are not as cost effective and that usually have generic equivalents available.
When a drug is not on a patient’s insurance formulary?
A drug formulary is a listing of prescription medications in different categories that determines how much you will pay for the medication. If a medication is “non-formulary,” it means it is not included on the insurance company’s “formulary” or list of covered medications.
What is formulary drugs vs non-formulary?
What is the type of coverage determination that is requested for non-formulary medications?
A formulary exception is a type of coverage determination request whereby a Medicare plan member asks the plan to cover a non-formulary drug or amend the plan’s usage management restrictions that are . . .
What is formulary drugs vs non formulary?
Who can prescribe non formulary medicines?
The consultant in charge of the patient’s treatment plan is the key individual who can initiate and prescribe non-formulary medicines.
Can a blue shield of California Plan cover a non formulary drug?
If coverage for a non-formulary drug requiring prior authorization is approved, you are responsible for the non-formulary copayment. Some plans underwritten by Blue Shield of California Life & Health Insurance Company do not cover brand-name drugs.
Where can I find the formulary for Blue Shield?
To find the formulary applicable to you, refer to your Evidence of Coverage or Certificate of Insurance to determine your plan name. The plan names are noted above each formulary in the list below. Drug formulary: Refer to your plans drug formulary for a list of Blue Shield preferred generic and brand-name medications.
What kind of drug coverage does Blue Shield have?
Blue Shield offers these types of outpatient prescription drug benefits. A closed formulary plan provides coverage for generic drugs, formulary brand-name drugs, and specialty drugs. Non-formulary drugs and most specialty drugs are covered only when prior authorization is approved.
Are there any non-formulary drugs that are covered?
Non-Formulary Drug: Celebrex*. Covered Formulary Alternative(s):etodolac (generic for Lodine),nabumetone (generic for Relafen),salsalate,sulindac. Non-Formulary Drug: Celexa. Covered Formulary Alternative(s):Effexor XR,Paxil,fluoxetine (generic for Prozac)