What is Value Formulary?

  • What is a formulary?

     A formulary is a list of medicines that are included on a prescription benefit plan. The plan will cover the medicines that are on this list, provided they are being used appropriately.


  • What are Value Formulary plans?

    There are three versions of Value Formulary: Value Formulary, Value Formulary Tiered and Value Formulary Narrow. Read the descriptions below to find out which version your plan has.

    Value Formulary

    This version covers generic medicines and listed brand medicines. Plans of this type do not cover unlisted brands.

    Example: For high cholesterol, the plan covers generic medicines (such as atorvastatin), but does not cover Crestor®.

    What This Means for You: Ask your doctor to write a prescription generic or listed brand drug, if your current prescription is for an unlisted brand. This way the drug will be covered at your pharmacy, and will help you avoid paying more for your prescription.


    Value Formulary Tiered

    This version covers generic medicines and listed brand medicines. VF Tiered plans cover unlisted brands, but at a higher cost to you. You may pay up to the full cost of the unlisted brands to fill these prescriptions.

    Example: For high cholesterol, the plan covers generic medicines (such as atorvastatin), and covers Crestor® at a higher cost to you.

    What This Means for You: Ask your doctor to write a prescription for a generic or listed brand drug, if your current prescription is for an unlisted brand. This will help you avoid paying more for your prescription.


    Value Formulary Narrow

    This version covers some generic medicines and listed brand medicines. VF Narrow plans do not cover unlisted generic or unlisted brand medicines.

    Example: For high cholesterol, the plan covers most generic medicines (such as atorvastatin, pravastatin and simvastatin). It does not cover unlisted brands like Crestor®. It also does not cover unlisted generics like lovastatin.

    What This Means for You: Ask your doctor to write a prescription for a listed generic or listed brand drug if your current prescription is for an unlisted generic or brand. This way the drug will be covered at your pharmacy, and will help you avoid paying more for your prescription.

  • What makes a prescription benefit plan “high value”?

    A plan is “high value” because:
    •    Many medicines included on the plan provide the same health benefits as more expensive options, but may cost up to 80% less**
    •    Medicines that cost more, but may not work better than lower-cost options, are not included or are included at up to the full cost, depending on your plan*
    •    It can help you and your doctor choose a lower-cost, effective option to treat your health condition

  • What does having a Value Formulary plan mean for you?

    In many cases, having a Value Formulary plan means you will pay less out-of-pocket costs for plan medicines than you did with your previous plan.† You may also have lower premiums each pay period, depending on your plan sponsor. With a Value Formulary plan, you will have access to the medicines in every therapeutic class, and may even pay less for them.‡ 

    Do you have questions about Value Formulary plans? Read our Member Frequently Asked Questions.

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