Specialty, infused and injectable prescription drugs - commercial and Medicaid/MassHealth ACO plans
Members requiring specialty medicines shown on the list below must use an in-network specialty pharmacy to get their medicine. (This does not apply to our Fallon Medicare Plus, NaviCare, or Summit ElderCare members.)
We are committed to providing patients seamless access to their medications while delivering on high-value clinical touchpoints and improving overall clinical outcomes. For the very small percentage of cases where a limited distribution product cannot be provided by our specialty pharmacy network, the limited distribution product can be filled at another participating pharmacy within the member's pharmacy network. Claims processing and billing activities are integrated to make the alternate vendor relationship transparent to Fallon Health members and physicians.
To get set up with specialty pharmacy, members can visit specialty.optumrx.com or call 1-855-427-4682.