Formulary
Also known as: Drug Formulary, Prescription Drug List
The list of drugs covered by a Medicare Part D or Advantage plan, organized into cost tiers.
A formulary is the list of prescription drugs that a specific Medicare Part D plan or Medicare Advantage with drug coverage (MAPD) plan will cover. Each drug is placed on a tier that determines the patient's cost-sharing: Tier 1 (generic, lowest cost) through Tier 5 or 6 (specialty drugs, highest cost).
For people with diabetes, formulary placement matters for insulins and diabetes medications. Not all insulin brands are on all Part D formularies. The $35/month insulin cap applies to all insulin on formulary; non-formulary insulin may not be capped at $35 and could cost more.
Formularies can change year-to-year during the Annual Notice of Change period (sent each fall). During Open Enrollment (Oct 15–Dec 7), reviewing whether your current medications remain on formulary at affordable tiers is one of the most important tasks for Medicare beneficiaries with diabetes.
Frequently asked
What is Formulary?
The list of drugs covered by a Medicare Part D or Advantage plan, organized into cost tiers. A formulary is the list of prescription drugs that a specific Medicare Part D plan or Medicare Advantage with drug coverage (MAPD) plan will cover. Each drug is placed on a tier that determines the patient's cost-sharing: Tier 1 (generic, lowest cost) through Tier 5 or 6 (specialty drugs, highest cost).
How does Formulary relate to Medicare coverage?
Medicare Part B covers most durable medical equipment related to Formulary. Contact us to verify your specific coverage for related diabetic supplies.
Where can I get diabetic supplies related to Formulary in Phoenix?
We deliver Medicare-covered diabetic supplies throughout the Phoenix metro area. Call us or complete the form above to verify your coverage.