Medications and pharmacy
Fallon 365 Care covers prescription medications and some over-the-counter (OTC) drugs with a prescription. Fallon 365 Care has a formulary, which is a list of the drugs we cover. A formulary is sometimes called a covered drug list.
How do I find out if a drug is covered?
You can find out if Fallon 365 Care covers a drug by searching for the drug on our online drug formulary.
How much will my prescriptions cost?
Most members must pay the following pharmacy copayments:
- $1 for certain covered generic drugs mainly used for diabetes, high blood pressure, and high cholesterol. These drugs are called antihyperglycemics (such as metformin), antihypertensives (such as lisinopril), and antilyperlipidemics (such as simstatin)
- $3.65 for certain over-the-counter (OTC) drugs for which you have a prescription from the doctor
- $3.65 for both first-time prescriptions and refills for certain covered generic and OTC drugs
- $3.65 for both first-time prescriptions and refills of covered brand-name drugs
You may get up to a 90-day supply on most medications. Your copay will still either be $1 or $3.65 (as noted above), even for a 90-day supply.
Which pharmacies can I go to?
You can fill prescriptions at thousands of pharmacies, including:
- CVS (including CVS inside Target stores)
- Rite Aid
- Price Chopper
- Shaw’s/Osco Drug
- Stop & Shop