Formulary
An insurance plan's covered-drug list with its tiers and rules — where GLP-1 coverage questions get answered first.
A formulary is the plan's menu: which drugs are covered, at what tier (and therefore copay), and behind which gates — prior authorization, quantity limits, step therapy. GLP-1 weight drugs, when covered at all, typically sit on high tiers with every gate engaged; the same molecule under a diabetes brand may sit differently, which is why Ozempic and Wegovy can have opposite coverage on one plan.
Reading yours takes ten minutes: plans publish formularies online, searchable by drug name, with the tier and restriction flags beside each entry. Formularies also change annually — a January surprise familiar to GLP-1 patients — making each open-enrollment season worth a re-check. Where the formulary says no, the appeal process and the self-pay lane are the remaining doors.
This glossary entry is general information, not medical advice, and is written to be consistent with FDA prescribing information and primary trial publications as of its last review. Always consult a licensed healthcare provider for personal medical decisions.
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