New-to-market medication evaluation
Screening of new drugs and technologies occurs through Fallon Health’s Pharmacy & Therapeutics Committee and Technology Assessment Committee, with input from national guidelines and research consortia. Fallon Health follows a new-to-market medication evaluation policy and usage determination for medications newly approved by the FDA.
Fallon Health has a waiting period (moratorium) of up to 180 calendar days for all new medications, in order to ensure enough time to determine true dosing parameters, side-effect profiles, drug-drug interactions, drug-disease state interactions, and age-related issues.
During this period, a physician can request the medication via the formulary exception process.
For Medicare only:
Medications or new indications of medications that fall within one of the following classes of clinical concern will be subject to the expedited review process:
- Antidepressants
- Anti-psychotics
- Anticonvulsants
- Anti-cancer
- Immunosuppressive
- HIV/AIDS
This process involves evaluation and usage determination for the preceding medications within 90 days of approval by the FDA. During this period, a physician can request the medication via the formulary exception process.