Health / Health Insurance / Formulary
Formulary: A listing of drugs, classified by therapeutic category or disease class, that are considered preferred therapy for a given managed population and that are to be used by an MCO's providers in . . . View Full Definition
Open Formulary: The provision that drugs on the preferred list and those not on the preferred list will both be covered by a PBM or MCO.
Closed Formulary: The provision that only those drugs on a preferred list will be covered by a PBM or MCO.
Therapeutic Substitution: The dispensing of a different chemical entity within the same drug class of a drug listed on a pharmacy benefit management plan's formulary. Therapeutic substitution always requires physicia . . . View Full Definition
Pharmacy And Therapeutics Committee: Committee charged with developing a formulary, reviewing changes to that formulary, and reviewing abnormal prescription utilization patterns by providers.
Generic Substitution: The dispensing of a drug that is the generic equivalent of a drug listed on a pharmacy benefit management plan's formulary. In most cases, generic substitution can be performed without physi . . . View Full Definition