Benchmark formulary

A formulary is a list of medicines that a health plan helps cover. A benchmark formulary is a drug list included in a state’s benchmark health plan.

Each state selects a benchmark health plan, which sets a standard for other health plans to meet. These plans cover all 10 essential health benefits, including the list of covered medications. Health plans must model the benchmark plan if they want to be sold on your state's health insurance Marketplace, on the individual market or to small employers.

For instance, let's say your state's benchmark plan covers 22 brand-name medications and nine generic drugs 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 class, but not necessarily the same ones.

 

WebMD Medical Reference Reviewed by Sarah Goodell on June 19, 2019
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