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Insurance FAQs Health

Prescription Drugs

  • How does the formulary work? View more
    The formulary for your health plan provides a list of medications that a team of health care specialists have approved. Your doctor will write a prescription based on your medical needs, but the formulary provides him with recommendations from the pharmacist and physician team. An effective formulary system provides a medication safety feature. When drugs and administration methods are systematically included (or deleted) in a controlled drug formulary, there are a number of benefits. For instance, each new drug added undergoes a peer review process that uncovers any safety concerns with the drug. Also, when drugs are systematically added to the formulary, there is adequate time to educate the staff before the drug is used. An organized formulary also ensures that the number and variety of drugs is kept to an effective minimum. There are approximately 13,000 prescription drugs on the market today and several drugs can often be used to treat the same condition. A formulary, based on safety and cost considerations, helps to limit the drugs recommended by your plan's health care professionals.
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  • How do I find out what drugs are on my health plan's formulary? View more
    Contact your health plan directly for this information.
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  • What is a generic drug? View more
    When a drug patent expires other companies may produce a generic version of the brand name drug. A generic medication, also approved by the FDA, is basically a copy of the brand name drug and is marketed under its chemical name. A generic drug may have a different color or shape than its brand name counterpart, but it must have the same active ingredients, strength, and dosage form (i.e., pill, liquid, or injection), and provide the same effectiveness and safety as its brand name counterpart.
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  • Do all brand name drugs have generic equivalents? View more
    No. Approximately half of all drugs on the market have generic versions.
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  • What are examples of each? View more
    Valium is a brand name drug whose generic counterpart is Diazepam. On the other hand, Amoxicillin is a generic drug of the brand drug Trimox.
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  • What is a brand name drug? View more
    A brand name drug is approved by the Food and Drug Administration (FDA), and is supplied by one company (the pharmaceutical manufacturer). The drug is protected by a patent and is marketed under the manufacturer's brand name.
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  • Is there a price difference between generic and brand name drugs? View more
    Yes. Generic drugs are less expensive than brand name products, and so the amount you pay as part of your prescription drug cost-sharing is less than what you pay for brand names. In addition, most plans charge you a lower copay if you use generic drugs.
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  • What is a formulary? View more
    A formulary is a list of both generic and brand name drugs that are preferred by your health plan. Often, many drugs on the market produce the same results equally well. Health plans will choose formulary drugs that are just as safe and effective as the alternatives but cost less. A team of pharmacists and physicians meet to review the formulary and make changes as necessary.
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  • I'm enrolled in a fee-for-service plan. How can I get the most value for my benefit dollar? View more
    Most FEHB fee-for-service plans offer Preferred Provider Organization (PPO) arrangements. When selecting your health care practitioner, your use of PPO providers whenever possible will help reduce your out-of-pocket expenses. In addition, PPO providers will generally file your claims for you. Read your plan's FEHB brochure carefully to find out about other incentives. Contact your plan to obtain the names of PPO providers in your area. You should also visit your plan's website (identified on the front of the plan's brochure and available by link from this website). Many plans provide up-to-date lists of PPO providers on their website.
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  • Is there a price difference between formulary and non-formulary drugs? View more
    You will usually pay more for a non-formulary drug when a formulary version is available.
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  • Why are drug costs on the rise? View more
    Cost increases are due to several factors.
    • Pharmaceutical companies are producing a record number of medications and many carry a high price tag. It cost an average of $500 million to discover and develop one new medicine, and it takes an average of 12 to 15 years to bring a new medicine from the laboratory to the pharmacy shelf.
    • Drugs are used more and more to avert illness and hospital admissions. Asthma, heart disease, and ulcers are among conditions successfully being treated with drugs.
    • The over-age 65 population is growing larger and living longer and this leads to an increase in the utilization of prescription drugs.
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  • What questions should I ask my doctor or pharmacist about any medicine prescribed or recommended for me? (Courtesy of the National Council on Patient Information and Education) View more
    Every day, millions of Americans rely on medications to feel better and get well, but it is not always easy to take them correctly. Not taking medications properly can prevent you from getting well as fast as you can. Also, taking medicine with certain foods, alcohol, dietary/herbal supplements, or other medicines might cause a dangerous reaction, or it might stop your medicine from working as well as it should. Here are some questions that can help you get the information you need to use your medicines properly. If the answers seem complicated or confusing, ask again!
    1. What is the name of the medicine and what is it supposed to do? Is this the brand name or the generic name?
    2. How and when do I take it -- and for how long?
    3. What foods, drinks, other medicines, dietary supplements, or activities should I avoid while taking this medicine?
    4. When should I expect the medicine to begin to work, and how will I know if it is working? Are there any tests required with this medicine (for example, to check liver or kidney function)?
    5. Are there any side effects, what are they, and what do I do if they occur?
    6. Will this medicine work safely with the other prescription and nonprescription medicines I am taking?
    7. Can I get a refill? When?
    8. How should I store this medicine?
    9. Is there any written information available about the medicine? Is it available in large print or a language other than English?
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  • My child will turn age 26 this year but she is disabled and incapable of self support. Can I continue to cover her under my FEHB enrollment? View more
    Your child age 26 or over who is incapable of self-support because of a disability that existed before age 26 may be eligible for coverage under your FEHB enrollment. For more information, please see the FEHB Handbook for Enrollees and Employing Offices.
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  • When I leave the FEHB Program, I understand I will receive a certification of my group coverage that I can use to get new coverage with my private industry employer. Will my agency or my plan certify my insurance coverage? View more
    We require FEHB carriers to issue certifications of prior coverage to enrollees. They issue certifications automatically whenever coverage terminates, whether it is termination of regular coverage, TCC coverage, or Spouse Equity coverage. If the plan does not certify your coverage, you should write to them and ask them to send you certification of coverage.
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  • Are generic drugs likely to cause more side effects than brand name drugs? View more
    There is no evidence of this. The FDA monitors reports of adverse drug reactions and has found no difference in the rates between generic and brand name drugs.
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Total Count: 17, Number of Pages: 2, Page: 1

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