Skip to content

Health Care Reform:

Health Insurance & Affordable Care Act

Back to ACA Health Insurance Terms List

Benchmark formulary

A formulary is a list of medicines that a health plan helps pay for. You'll often hear this drug list referred to as medicines that the plan covers. A benchmark formulary is a list of medicines that set a standard for other health plans to meet. It is a drug list that other health plans use as a model.

Each state selects a benchmark formulary for health plans to follow if they want to be sold on your state's health insurance Marketplace.

For instance, let's say your state's benchmark formulary covers 22 brand-name medicines and nine generic medicines in a certain drug class. Health plans sold on your state's Marketplace must cover at least the same number of brand name and generic ones in that drug category, but not necessarily the same ones.

WebMD Definition

Health Insurance Terms

URAC: Accredited Health Web Site TRUSTe online privacy certification HONcode Seal AdChoices