In a Marketplace plan, what is a formulary?

• A. A schedule of premium payment due dates.
• B. A published list of covered prescription drugs, with tiers and potential prior authorization requirements.
• C. A chart of preferred hospitals only.
• D. A list of out-of-network providers.

Answer: (B)

A formulary is a published list of prescription drugs that a marketplace plan covers, organized into tiers that determine your cost share. It may also include any prior authorization requirements for certain medications. In practice, this means the formulary shows which drugs are covered, how much you’ll pay at each tier, and whether your doctor needs to get special approval before the plan will cover a drug. This is distinct from lists or charts about premiums, hospital networks, or provider directories, which relate to payments or where you can receive care rather than which medications are covered.