We believe patients should have access to adequate formularies that do not discriminate against any medical conditions and ensure patients have affordable access to prescription drugs, devices, and other therapies. Tiering and pre-authorization limitations are becoming more common in formularies, and problems persist with access to devices and allied health professionals such as physical therapists.
Health insurance plans may have websites where patients can search for a plan’s prescription formulary, understand what tier specific drugs are on, and what restrictions apply. However, formularies can change after the enrollment period and exclusions, tiering and consumer costs could vary throughout the year. Clear, accurate and up-to-date information should be required, as well as fair and stable formularies that do not change within the plan year and do not limit patient or provider access to needed prescriptions.