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. 

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

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.