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Cost & insurance

Formulary

The list of medications your insurance plan agrees to cover, usually sorted into tiers that determine your copay. If a drug isn't on the formulary, you'll pay full price unless you win a formulary exception. Formularies change yearly and mid-year, which is why people are sometimes forced to switch GLP-1s even when their current one is working.

Related terms: Formulary exclusion · Step therapy · Prior authorization (PA)

See also: Appeal letter templates

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