AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

AMA Journal of Ethics. June 2017, Volume 19, Number 6: 629-630.
doi: 10.1001/journalofethics.2017.19.6.imhl1-1706.

Images of Healing and Learning

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Dirty Laundry: Drug Formulary Exclusions

The image, “Dirty Laundry: Drug Formulary Exclusions,” calls attention to how drug formularies undermine physicians’ and patients’ medical decision making.

Artwork and caption by Katy Giebenhain, MA, MPhil

Figure 1. Detail of Dirty Laundry: Drug Formulary Exclusions, by Katy Giebenhain
(Click image to enlarge.)
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Pharmacy benefit managers (PBMs) 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.

Editor’s Note

Four lines of text appearing in Dirty Laundry are contextualized as follows: Note to existing members: This 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/caremarkTM 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].


  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.

Katy Giebenhain, MA, MPhil, is the associate director of communications at the Gettysburg Seminary in Gettysburg, Pennsylvania, and the poetry + theology rubric editor for Seminary Ridge Review. She is the author of Sharps Cabaret (Mercer University Press, 2017) and is on the Gettysburg National Military Park Artist-in-Residence local committee. Her interests include narrative medicine.

A Single-Payer System Would Reduce U.S. Health Care Costs, November 2012

We Got Your Back: Patient Advocacy Through Art, January 2016

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