Formulary FAQ

Hyde Rx wants you to understand your pharmacy benefits and the Hyde Rx Value Based Formulary. Below is a list of Frequently Asked Questions about our formulary.

Q: What is a formulary?
A: A formulary is a list of preferred prescription drugs selected for their safety, efficacy, and cost by a panel of experts. If a generic drug is not available for your medical condition, be sure to ask your doctor to prescribe a brand name drug on the formulary (the second tier). Otherwise, you may end up spending more money for little or no improvement in safety or efficacy

Q: Should I use generic drugs?
A: Generic drugs have several major advantages over brand name drugs. They are subject to the same safety and efficacy regulations by the FDA as brand name drugs. The FDA assures you that generic drugs are therapeutically equivalent to their brand name counterparts. Most people are aware that generic drugs usually cost much less than brand name drugs, but there is an additional advantage. Generic drugs may be safer. In recent years, several newer brand name drugs have had to be removed from the market because of safety problems (including deaths) that were discovered only after the drugs were initially approved for sale. You may have heard of Baycol, Seldane, and Rezulin, all top-selling brand name drugs which were implicated in the deaths of patients and which had to be removed from the market. Generic drugs are more likely to have withstood the test of time and extensive use, something that many new (and more expensive) brand name drugs cannot claim.

Q: What is a 3-tier benefit?
A: (Check your benefit plan to see if this applies to you). Drugs under a 3-tier copayment structure are listed in one of three groups or tiers. Generic drugs are in Tier 1 and have the lowest copayment. Preferred brand name drugs are in Tier 2 and require a higher copayment. Non-preferred brand name drugs are in Tier 3 and require the highest patient copayment. Note: Brand name drugs that have a generic equivalent may be covered only at the generic price.

Q: What is a formulary drug?

A: A formulary drug is any drug that is listed in either Tier 1 (generics) or Tier 2 (preferred brand name).

Q: If a drug is not listed in Tier 1 or Tier 2 (i.e., not a formulary drug), will it always be included as a benefit under Tier 3?

A : Not always. (1) All generic drugs are considered Tier 1 formulary drugs, although some may not be specifically listed in Tier 1. (2) Other drugs have been determined by Hyde Rx's Pharmacy and Therapeutics Panel to offer no significant benefit over drugs that are available in Tiers 1, 2, & 3, or over-the-counter (OTC), and are not covered under your benefit plan. If you purchase such drugs, you may be required to pay the entire cost, although you may still receive a discount by purchasing from a contracting network or mail service pharmacy. (3) Some brand name drugs not listed may be covered. You can find out by emailing Hyde Rx member services with a specific drug query at info@HydeRx.com