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Be a Wise Healthcare Consumer
The Prescription Drug Formulary
Your UT SELECT coverage provides benefits for a wide range of medications. Depending on whether a medication is generic, preferred, or non-preferred, your out-of-pocket copayment amount varies. A prescription drug formulary includes all of the brand name and generic medications that are preferred by your prescription plan.
Developing the Formulary
Express Scripts has assembled an independent group of doctors and pharmacists, called the Pharmacy and Therapeutics Committee, that is responsible for reviewing the formulary used for the UT SELECT Prescription plan and for helping to ensure that policies are medically sound and support your health. The committee makes a decision about whether a specific medication will become part of the formulary after completing a detailed assessment of the medication’s safety and effectiveness, including a comparison with existing formulary medications in the same class, if any.
During its review of a new medication, the committee determines whether the medication has a specific clinical advantage over other available medications. If it does, then it may be selected for inclusion in the formulary based on that difference. Often, there will already be other, less expensive drugs included in the formulary that treat the same condition as effectively as a newer, more expensive option. Relying on less expensive formulary options whenever possible means lower costs for the UT SELECT plan as well as for you since you will usually pay a lower copayment for formulary (preferred) drugs.
In order to help control rising prescription drug costs, formularies are updated from time to time. When the Pharmacy and Therapeutics Committee determines that a different, less expensive medication can effectively treat the same condition, then a medication that has been in the formulary but is more expensive may be moved to a non-formulary (non-preferred) status. For example, if new generics have become available in a given category of drugs, some brand name products may be removed from the formulary. Also, if new medical research indicates that a less expensive medication is just as safe and effective as its more expensive counterpart, the more expensive medication may be moved to non-preferred status.
Choosing the Best Medication for Your Personal Needs
If you are prescribed a non-formulary (non-preferred) medication, you may want to talk with your medical provider about whether a generic or brand name formulary (preferred) drug might work just as well for you. In most cases a medication that can effectively treat your condition will be available through the formulary.
If you do need to use a non-formulary (non-preferred) medication, your plan still helps control your costs because your copayment is generally less than what a medication actually costs. In fact the copayment that you pay, particularly for non-formulary medications, may represent only a fraction of a medication’s total cost. The UT SELECT plan pays the rest of the cost on your behalf.
The UT SELECT plan and Express Scripts are committed to ensuring that you receive the care that you need to stay healthy. For information on less expensive alternatives for a particular medication, please call Express Scripts customer service at (800) 818-0155, or visit www.medco.com/ut.