Online drug formulary
Choose your formulary:
Our formularies display our drug criteria. Look for the “PA” symbol
to view criteria.
Note: A single asterisk (*) represents a bullet and double (**)
or triple (***) asterisks represent sub-bullets in our criteria.
Please note:
- Pharmacy benefit quantity limits are not applicable for medical
benefit drugs.
How to choose a formulary
Step 1: Check to see if the member has pharmacy benefits.
Whether or not the member has pharmacy benefits through Fallon Health depends on the plan he or she is enrolled in and/or the employer group he or she gets insurance through. The simplest way to check if a member has pharmacy benefits is to look at his or her health plan ID card. If the member has pharmacy benefits through Fallon, you'll seen OptumRx logo on the front of the card.
| Yes, there's an OptumRx logo on the ID card. |
No, there isn't an OptumRx logo on the ID card. |
Member has pharmacy benefits through Fallon.
Go to step 2 below. ↓ |
Member doesn't have pharmacy benefits through Fallon. |
Step 2: Find the member's plan name.
If the member has pharmacy benefits through Fallon, the next step is to find the member's plan name. You can find the plan name on the right side of the member's health plan ID card.
If the plan name is:
| Fallon Medicare Plus |
NaviCare |
Berkshire Fallon Health Collaborative, Fallon 365 Care or Fallon Health-Atrius Health Care Collaborative |
Community Care |
| Choose "Fallon Medicare Plus" from the pull-down menu at the top of the screen. |
Choose "NaviCare" from the pull-down menu at the top of the screen. |
Choose "MassHealth" from the pull-down menu at the top of the screen. |
Choose "Commercial 3-Tier" from the pull-down menu at the top of the screen. |
If you need help choosing a formulary, call our Customer Service Department at 1-800-868-5200 (TTY users, please call TRS Relay 711), Monday, Tuesday, Thursday, and Friday from 8 a.m. to 6 p.m. and Wednesday from 10 a.m. to 6 p.m. MassHealth members can call Fallon Customer Service at: 1-800-341-4848. (TTY users, please call TRS Relay 711), Monday through Friday, 8 a.m. to 6 p.m.