What is meant by a non-formulary medication?

A non-formulary medication refers to a prescribed medication that is not included on a specific health plan's list of preferred drugs. This list, known as a formulary, is established by insurance providers to outline which medications are covered under a particular health plan. Medications on this list typically involve considerations such as effectiveness, cost, and overall value.

When a medication is classified as non-formulary, it means that it may not be covered by the insurance plan, or it may come with higher co-pays or additional restrictions. This designation generally signals that a physician must often provide justification for why a non-formulary medication is necessary for the patient's treatment, especially if a formulary alternative is available. The focus on the insurance coverage aspect distinguishes it from preferred drugs and ensures that patients and healthcare providers are well-informed about the options available to them.

Other options may reflect related concepts, but they do not accurately capture the essence of what non-formulary means in the context of medication management and insurance coverage.