Covered medications—online drug formulary

To search the online drug formulary, first choose the name of the plan you're interested in:

Download printable versions of the formularies

Individual

  • Fallon Senior Plan 2017 Formulary Opens in a new window
    (pdf, H_9001_F_2017_43_r1 Accepted 09202016, Formulary ID: 00017301 Version: 12, Last updated: April 25, 2017)
    Please note: This printable formulary was last updated on April 25, 2017. It is subject to change at any time. For more information on the most recent list of drugs, see our online Part D drug formulary, or contact Fallon Senior Plan at 1-800-325-5669 (TRS 711), 8 a.m.–8 p.m., Monday–Friday. (Oct. 1–Feb. 14, seven days a week.)

Group

  • 2017 Fallon Senior Plan Group 1 HMO formulary Opens in a new window (pdf, Formulary ID: 00017300 Version: 13, Last updated: April 25, 2017) Please note: This printable formulary was last updated on April 25, 2017. It is subject to change at any time. For more information on the most recent list of drugs, see our online Part D drug formulary, or contact Fallon Senior Plan at 1-800-325-5669 (TRS 711), 8 a.m.–8 p.m., Monday–Friday. (Oct. 1–Feb. 14, seven days a week.)

Formulary changes

You may view the addendum documents below to see if there are changes to the Fallon Senior Plan formularies. If there are no documents listed below, then there are currently no changes to the list of covered medications.

Fallon Senior Plan Formulary Addendum (Last updated April 25, 2017)

Fallon Senior Plan Group 1 Formulary Addendum (Last updated April 25, 2017)

Prior authorization and step therapy

Prior authorization

Fallon requires your physician to get prior authorization for certain drugs. This means that you will need to get approval from Fallon before you fill your prescriptions. If you don’t get approval, Fallon Senior Plan may not cover the drug. If a drug requires a prior authorization, you'll see a "PA" next to the drug in the online drug formulary search. You can click on the "PA" symbol to see the prior authorization criteria for that medication.

Step therapy

In some cases, Fallon Health requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Fallon Senior Plan may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Fallon Senior Plan will then cover Drug B.

Drugs with step therapy requirements:

To view the PDF files above, you may need to download a free copy of Adobe® Acrobat Reader software on your computer. (This link takes you away from the Fallon Senior Plan website.)

Fallon Health is an HMO/HMO-POS plan with a Medicare contract. Enrollment in Fallon Health depends on contract renewal.This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits may change on January 1 of each year.The Formulary may change at any time. You will receive notice when necessary.

H9001_F_2017_21 Approved 10172016
The information on this page was last updated on 10/1/2016.

Call us toll-free at 1-888-340-5504 (TRS 711), 8 a.m.–8 p.m., Monday–Friday. (Oct. 1–Feb. 14, seven days a week.)

Helpful information about medications and our online drug formulary

Medicare Part D online forms