Join Early Retirement Today
Thread Tools Search this Thread Display Modes
Non Formulary
Old 11-11-2015, 06:48 AM   #1
Confused about dryer sheets
Join Date: Feb 2014
Location: lincoln
Posts: 8
Non Formulary

Under ACA silver plans with cost sharing,are non formulary drugs covered after the OOP maximum has been reached or are they not covered at all? Thanks for any help.Mike.

25ring is offline   Reply With Quote
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Old 11-11-2015, 09:04 AM   #2
Recycles dryer sheets
Join Date: Jan 2014
Posts: 495
It depends on why the drug is not on the formulary. A self-admininstered drug not on the formulary would not be covered before or after the MOOP has been met unless an exception has been granted. Each plan is required to have an 'exception process' (aka appeal process) to have a drug added for that specific member. That does not mean the drug will be added.

Intravenous drugs that must be administered in an office/clinic setting fall under the medical benefit, not the drug benefit, and often never appear on the self-admin formulary. You need to contact the plan to see which of these are covered. If covered, then it's like any other medical benefit that is paid after MOOP if in-network.

Challenges of Reimbursing Through the Medical vs. Pharmacy Benefit | Biologic Specialty Pharmacy

MBSC is offline   Reply With Quote

Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off

Similar Threads
Thread Thread Starter Forum Replies Last Post
2016 Express Scripts & Caremark Drug Formulary Changes MBSC Health and Early Retirement 7 08-06-2015 07:14 PM
Oil Spill -- Non-Political & Non-Legal Issues TromboneAl Other topics 52 07-29-2010 04:52 PM
Gifts of money to a non-resident-non-citizen? Urchina Other topics 10 02-22-2009 11:41 AM
7% SWR (non-inflation protected) newellcr FIRE and Money 5 11-13-2004 08:25 PM
Non-deductible 401k contributions friendlygirl FIRE and Money 3 07-01-2002 10:01 AM


All times are GMT -6. The time now is 08:17 AM.
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2016, vBulletin Solutions, Inc.