Problem
Every insurance plan has a formulary, which is a list of covered medications. In some cases, drugs of similar categories are covered, but at different costs. At times, only one drug from a specific category is covered. It can be challenging for both pharmacies and prescribers to predict what medications will be covered and at what cost, especially generic therapies.
Consider the best option that pharmacy personnel can utilize when a medication is not covered by a plan or requires prior authorization. Keep in mind that many drugs have a bioequivalent, or drugs that are considered therapeutically equivalent. Discuss all options that could be provided to patients in this situation and explain which option you think is best.