nonformulary

nonformulary

(non″for′myŭ-ler″ē) [ non- + formulary]
Not approved for use. The term is applied to a drug whose prescription is not usually reimbursed by a health insurer because it is absent from its formulary.
References in periodicals archive ?
The medical program director is responsible for the supervision and clinical support of the medical providers and midlevel providers working within RIDOC, approving consultants, outside referrals, nonformulary medications and labs, medical furloughs, medical complaints and outside elective medical care.
An unintended consequence could be, ironically, that it may decrease access for women because if contraceptives are reclassified as nonformulary drugs by going over the counter, can insurance companies say they're not going to cover them as they don't cover aspirin, for instance?
Outside documentation that supports a current nonformulary medication regimen can be crucial to a smooth transition of care.
For example, between 2000 and 2011, the average copayment for brand name (preferred) drugs on a plan's formulary increased from $15 to $29, while the average copayment for nonformulary (nonpreferred) brand name drugs increased from $29 to $49.
2007) conducted a 2-year, pre-post study of formulary changes within a single, large health plan and noted that implementing a third tier or increasing member copayments was associated with a 1-4 percent decrease in nonformulary drug use, a comparable increase in both generic and preferred drug utilization, and an approximate doubling of mail service use.
DOD's decision to designate a drug as either formulary or nonformulary is based on the drug's clinical and cost-effectiveness relative to the other drugs in its therapeutic class.
The prescriber would then deal with any fallout after the fact, in terms of the prescribing of a nonformulary, third tier, or otherwise restricted agent.
The American Medical Association and America's Health Insurance Plans, in conjunction with the Centers for Medicare and Medicaid Services, have released a model standardized exception and prior-authorization form that physicians may use to request an exception and coverage for nonformulary drugs.
It is also beneficial if an LTC facility nurse or pharmacist can act on behalf of a resident's physician to seek prior authorization for nonformulary drug requests.
With Zero Dollar Copay, prescription plan sponsors can give members using nonformulary brand drugs a significant financial incentive to consider using lower-cost generics, saving money through greater generic-drug utilization without shifting costs to plan members.
4% of the errors, and prescribing-based causes (such as wrong dosage or nonformulary drugs) accounted for 18.