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Glossary Terms

What is a Formulary?

What is a Formulary?

A formulary is a list of medications. The term is often used in the context of generic and brand-name prescription drugs covered by a health insurance plan.

With a formulary, healthcare providers know which drugs they can prescribe that will be covered by the patient’s health plan. Developing a formulary also allows the insurer to research which medications are safe and effective for specific treatments. Formularies are routinely updated to encompass new medications and treatments.

It is important to keep your Electronic Health Record (EHR) or Electronic Medical Record (EMR) updated with the latest formularies of medications covered by insurance plans. This allows physicians to prescribe medications that a patient's plan will cover, improving the likelihood of medication adherence.

Why are Medicare Formularies Important?

In the United States, most individuals who are 65 or older and those with special needs and disabilities are covered by one of the federal government’s Medicare plans. Given Medicare’s widespread adoption, adherence to its formulary is important to the American healthcare industry.

The four parts of Medicare are:

- Part A is for inpatient or hospital-related care and services.

- Part B is for outpatient care, doctor appointments, and related care. 

- Part C: Private insurance companies offer this plan, with a combination of plans A and B. Part C is also known as Medicare Advantage.

- Part D is for prescription drugs. 

Each part will use a different formulary, requiring healthcare organizations and providers to be familiar with each. This helps patients receive the medications needed for their specific treatments. 

How Does a Medicare Dual-Eligible Formulary Work?

In addition, some people will qualify for both Medicare and Medicaid. These patients are known as “dual eligible.” They will typically have severe and long-term health conditions that require specialized treatments.

Dual-eligible health plans are a form of Medicare Advantage and may have specifically-tailored formularies and benefits that meet their needs.

How TempDev Can Help With a Formulary

TempDev’s team of NextGen consultants, developers, and trainers can help you implement, switch, or even upgrade your current EHR system. From dashboardstemplates, and reports to revenue cycle consulting, automation, and workflow redesign, TempDev offers the tools you need to make the most of your NextGen EHR system.

Our team is here to help you design, organize, and implement the whole system, with top tips and guidance based on industry best practices

Contact us here or call us at 888.TEMP.DEV to get the help you need working with formularies from Medicare and other health insurance plans.


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