{"id":50092,"date":"2022-03-25T19:55:43","date_gmt":"2022-03-25T23:55:43","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=50092"},"modified":"2026-02-08T14:13:54","modified_gmt":"2026-02-08T19:13:54","slug":"medicare-formulary","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/medicare-formulary\/","title":{"rendered":"What is a Medicare formulary?"},"content":{"rendered":"

For many, prescription drugs are a necessity that contributes to much of their healthcare spending. Medicare prescription drug coverage through Part D provides millions of Americans help to cover some of these costs.\u00a0<\/span><\/p>\n

With any prescription drug plan, it\u2019s important to understand what medications are covered to ensure you have the best plan for your prescription drug needs. Here is an overview of Medicare Part D drug formularies, including the drugs covered, common plan rules and restrictions, and how to find the best plan for your list of medications.<\/span><\/p>\n

What is a Medicare drug formulary?<\/span><\/h2>\n

A <\/span>drug formulary<\/span><\/a> is a health plan\u2019s list of covered drugs. Most plans with drug coverage, including Medicare and non-Medicare plans, have their own drug formulary. These formularies are created by Pharmacy and Therapeutics (P&T) committees for each individual health insurance company.<\/span><\/p>\n

The <\/span>Centers for Medicare and Medicaid Services (CMS)<\/span><\/a> then reviews the formularies to ensure that plans offer comprehensive drug benefits that provide beneficiaries with cost-effective access to necessary medications.\u00a0<\/span><\/p>\n

\u201cMedicare formularies include generic and brand-name prescription drugs,\u201d says<\/span> Ashley Woodcox<\/span><\/a>, BSHCA, executive director of <\/span>Brookdale Senior Living<\/span><\/a>. \u201cMany plans divide the covered drugs into tiers, or levels, based on cost. Drugs in a lower tier will generally have a lower copayment than non-preferred drugs in a higher tier.\u201d<\/span><\/p>\n

While each plan can divide its tiers how they choose, an example of a drug plan\u2019s tiers may include:\u00a0<\/span><\/p>\n