Art of Medicine
Jun 2017

Dirty Laundry: Drug Formulary Exclusions

Katy Giebenhain, MA, MPhil
AMA J Ethics. 2017;19(6):629-630. doi: 10.1001/journalofethics.2017.19.6.imhl1-1706.

Figure. Detail of Dirty Laundry: Drug Formulary Exclusions

Dirty Laundry: Drug Formulary Exclusions


Pharmacy benefit managers contracted by health insurance companies create lists or “formularies” of preferred medications they cover. In this artwork, information from such formulary lists supplied the source of the text. This practice of charging patients the full cost for medications, devices, or monitoring aids that are excluded from their health insurance companies’ coverage plans undermines decision-making partnerships between physicians and patients. An ethically relevant irony explored here is that in the United States we seem to have more choice about, and access to, breakfast cereals and assault rifles than needed medications.


  1. CVS/caremark. 2015 Advance formulary list: frequently asked questions. Accessed May 5, 2017.

  2. CVS/caremark. Your covered medicine list: check for updates that may affect your prescription cost. Accessed May 5, 2017.

Editor's Note

Four lines of text appearing in Dirty Laundry are contextualized as follows: Note to existing membersThis formulary has changed since last year and please bring this guide with you the next time you visit your doctor and similar language appears in numerous web-based sources of information about formulary lists. If you choose to remain on your current medication, you may use any retail pharmacy and should expect to pay the full cost of those prescriptions appears on the CVS/caremark website [1]. Please review the Formulary Drug Removals in the link below. This contains a list of drugs that will no longer be covered on your drug list. This means you will pay the full price if you continue with any of these drugs also appears on the CVS/caremark website [2].


AMA J Ethics. 2017;19(6):629-630.



The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.