Health insurance glossary
Formulary
Plain-English definition
A formulary is the list of prescription drugs a drug plan pays for, along with any conditions attached to each one, such as requiring a lower-cost equivalent or approval in advance. Public drug programs publish their formularies, and private plans set their own. A drug your doctor prescribes is covered only if it is on the plan's list or approved through an exception.
By the HealthRate editorial desk
How it works
Each public program keeps its own list: Ontario's is the Ontario Drug Benefit Formulary, Alberta's is the Alberta Drug Benefit List and Quebec's is the List of Medications. A drug listed in one province may be unlisted, or listed with different conditions, in another.
Private plans decide their own lists and rules. They can differ on generic substitution, which drugs need approval in advance, annual maximums and the share you pay, so the plan's own list is the only reliable answer for that plan.
To check a drug, find its Drug Identification Number (DIN), the eight-digit number on the label, and ask the plan whether that exact product is covered and on what terms.
Why it matters
Two plans can both say they cover prescription drugs and still treat your medication differently. Checking the formulary before you buy a plan or fill a prescription is how you avoid an unexpected bill at the pharmacy.
Not to be confused with
A formulary is not a price list. Being on the formulary means a drug is eligible; what you pay still depends on the plan's deductible, co-payment or coinsurance.