What a formulary is
A formulary is the list of prescription drugs a plan covers. HealthCare.gov
Prescription coverage
Make sure your medications come with you.
Two plans with the same premium can treat the same drug very differently. Check the formulary and tier for every medication before you choose a plan.
What to review
Focus on the details that change the decision.
Tiers drive your cost
Plans sort drugs into tiers: generics cost least, then preferred brands, non-preferred brands, and specialty drugs for complex conditions. NAIC
You can ask for an exception
If a drug isn't covered, your doctor can support an exception request, for example when covered drugs haven't worked. HealthCare.gov
Deadlines plans must meet
For ACA plans, a standard exception request must be decided within 72 hours and an urgent one within 24 hours. 45 CFR 156.122
General education, not advice for your situation. Sources, checked October 2, 2026: healthcare.gov · healthcare.gov · content.naic.org · ecfr.gov.
Your coverage review
Bring the basics. Leave with clearer next steps.
- Share the situation.Who needs coverage, ZIP code, timing, current coverage, and why you are reviewing.
- Name the priorities.Budget, providers, prescriptions, travel, and expected care.
- Review relevant paths.Understand tradeoffs and questions to verify before deciding.
Common questions
Know what to expect.
General education only. Exact options require an individual review.
How do I check if my drug is covered?
Look up each medication, strength and form on the plan's current formulary, and note the tier and any prior authorization or step therapy rules.
What if my exception is denied?
You can ask for an independent external review of the decision.
Can you compare my drugs across plans?
Yes. Bring your medication list to the review and compare plans side by side.
Ready when you are
Turn the research into a personal review.
Send the essentials or choose a time. Requesting information does not enroll you.