Covered medications—online drug formulary

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Printable formularyFallon Health Formulary (pdf, last updated: 05/23/2024) 

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Part B 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, your plan may not cover Drug B unless you try Drug A first. If Drug A does not work for you, your plan will then cover Drug B. Step Therapy may be required for the medications listed in the table below.

  • Abraxane
  • Aloxi
  • Avastin/Alymsys/Vegzelma
  • Beovu
  • Cimerli
  • Durolane/Gel-One/GelSyn3/
    GenVisc 850/Hyalgan/
    Orthovisc/sodium hyaluronate/
    Supartz/Supartz FX/
  • Eylea
  • Fusilev/Khapzory
  • Herceptin Hylecta
  • Herceptin/Ontruzant/Herzuma
  • HP Acthar
  • Lucentis/Byooviz
  • Macugen
  • Neupogen
  • Procrit/Epogen (non-ESRD)
  • Prolia/Xgeva
  • Purified Cortrophin Gel Remicade/Avsola/Renflexis/infliximab
  • Releuko/Granix/Nivestym
  • Rituxan Hyleca
  • Rituxan/Riabni
  • Rolvedon
  • Soliris
  • Sustol
  • Susvimo
  • Treanda/Vivimusta
  • Trivisc/VISCO-3/Triluron
  • Udenyca/Ziextenzo/Nyvepria/ Stimufend/Fylnetra
  • Vabysmo
  • Zilretta
Call us toll-free at 1-888-340-5504 (TRS 711), 8 a.m.–8 p.m., seven days a week.
(Apr.–Sept., we are available 8 a.m.–8 p.m., Mon.–Fri.)

H9001_240093_C | The information on this page was last updated on 10/1/2023.

Formulary changes

The documents below show changes to the Fallon Medicare Plus formulary. If there are no documents listed below, then there are currently no changes to the list of covered medications.