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Know Your Plan: Formularies

Question 2: What medicines does a formulary include?

When there are multiple medicines in the same drug class, drug plans may decide not to include all of those drugs on their formularies. Federal rules require Medicare drug plans to cover at least two drugs in each class.

The plans negotiate prices with the manufacturers of each medication in the class and then decide which medicines in the class to include on the formulary. This means that some higher priced medicines may not be included on the formulary. Alternatively, the drug plan may place certain medications in a higher copay tier, so that you have to pay more out-of-pocket in order to get them.