What does the term 'formulary' mean in Medicare Advantage plans?

The term 'formulary' specifically refers to a comprehensive list of prescription drugs that a Medicare Advantage plan covers. This list typically categorizes medications by different tiers, which can indicate different levels of cost-sharing for the beneficiary. The formulary is crucial for members as it informs them about which medications are available under their plan and any restrictions that might apply, such as prior authorization or quantity limits.

Understanding the formulary is essential for beneficiaries because it directly impacts their access to necessary medications and their out-of-pocket costs. Plans often update their formularies annually or periodically, so staying informed about any changes is important for members to manage their healthcare effectively.