Fallon Medicare Plus Blue HMO (HMO) Formulary



Below is the 2023 Formulary, or prescription drug list, from Fallon Medicare Plus Blue HMO (HMO) by Fallon Community Health Plan. A formulary is a continually updated list of available medications and prescription drug cost information. Examining a plans formulary can help you find a Massachusetts Medicare Part-C plan that covers your prescriptions. It also helps you compare costs among Medicare Part D and Medicare Advantage plans available to you. You’ll want to make sure the medicines you are currently taking are covered under any plans you are considering enrolling in.

This Fallon Medicare Plus Blue HMO (HMO)(H9001-031) plan has a $0 drug deductible. The Initial Coverage Limit (ICL) for this plan is $4660. The Initial Coverage Period is the period after the Deductible has been met but before the Coverage Gap phase. Once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will enter the coverage gap. (AKA "donut hole") Once you reach the coverage gap you will be required to pay 25% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. You can see if this plan offers coverage in the "donut hole" by clicking the "Coverage Gap" link above the chart.

In 2023 if you have spent $7400 in expenditures you enter the Catastrophic Phase. During the Catastrophic Period you will begin to receive significant coverage. Fallon Community Health Plan will begin paying approximately 95% of your covered medication expenses. You can see if this plan covers your drugs in the Catastrophic Phase by clicking the "Catastrophic" link above the chart.



Plan Overview

Plan Name:Fallon Medicare Plus Blue HMO
Plan ID: H9001-031
Provider: Fallon Community Health Plan
Plan Year:2023
Premium:$47.70
Deductible:$0
Initial Coverage Limit:$4660
Coverage Area:Massachusetts
Similar Plan:H9001-035


Change Table Options:

Drugs Starting Letter:
Coverage Phase:

*Tip Click the Drug name to Compare Coverage and Retail Cost for Every Plan In Your Area
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Drug
Name⇅
Tier
Level
Cost
Preferred
Cost
Non
Preferred
Cost
Mail
Limit
Amt/Days
Prior Auth
Y/N
Step
Therapy
Famciclovir
2NA$7NANN
Famotidine
2NA$7NANN
Fanapt
4NA$86NANY
Farxiga
3NA$37NANN
Fasenra
5NA33%NAYN
Febuxostat
2NA$7NANN
Felbamate
2NA$7NANN
Felodipine
2NA$7NANN
Femring
4NA$86NANN
Femynor
2NA$7NANN
Fenofibrate
2NA$7NANN
Fenoprofen Calcium
1NA$0NANN
Fentanyl
2NA$7NANN
Fentanyl Citrate
5NA33%NA4/1YN
Fentanyl Transdermal
2NA$7NANN
Fetzima
4NA$86NAYN
Firdapse
5NA33%NAYN
Firvanq
1NA$0NANN
Flac Otic Oil
2NA$7NANN
Flavoxate Hydrochloride
2NA$7NANN
Flebogamma Dif
6NA$0NAYN
Flecainide Acetate
2NA$7NANN
Flovent
3NA$37NANN
Fluconazole
2NA$7NANN
Flucytosine
5NA33%NANN
Fludrocortisone Acetate
2NA$7NANN
Flunisolide
2NA$7NANN
Fluocinolone Acetonide
3NA$37NANN
Fluocinonide
4NA$86NA60/30NN
Fluorometholone
2NA$7NANN
Fluorouracil
4NA$86NANN
Fluorouracil Cream
5NA33%NANN
Fluoxetine
2NA$7NANN
Fluoxetine Hydrochloride
2NA$7NANN
Fluphenazine Decanoate
2NA$7NANN
Fluphenazine Hydrochloride
4NA$86NANN
Flurazepam Hydrochloride
2NA$7NA30/30NN
Flurbiprofen
2NA$7NANN
Flurbiprofen Sodium
2NA$7NANN
Fluticasone Propionate
4NA$86NA240/30NN
Fluvoxamine Maleate
2NA$7NANN
Fml
3NA$37NANN
Fml Forte
3NA$37NANN
Fondaparinux Sodium
5NA33%NANN
Fosamax Plus D
4NA$86NANN
Fosamprenavir Calcium
5NA33%NANN
Fosfomycin Tromethamine
2NA$7NANN
Fosinopril Sodium
1NA$0NANN
Fosinopril Sodium And Hydrochlorothiazide
2NA$7NANN
Fotivda
5NA33%NAYN
Fragmin
5NA33%NANN
Furosemide
2NA$7NANN
Fuzeon
5NA33%NANN
Fycompa
5NA33%NAYN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H9001-031

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1. Pre-Deductable: Before you reach the plans deductible of $0. Some plans offer select Pre-deductible drug Coverage
2. Initial Coverage: (ICL) After you reach the plans deductible but before the Initial Coverage limit of $4660
3. Coverage Gap: (AKA Donut Hole) After you reach the plans ICL but before the Catastrophic of $7400 in 2023.
4. Catastrophic: Anything over $7400 you will receive a significant increase in coverage.

Definitions:

Premium: A monthly flat fee that varies by plan.
Deductible: The amount you must pay each year for your prescriptions before your plan begins to pay its share of your covered drugs. The max in 2023 is $505. Some plans have a $0 Deductible.
Tier Level: Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost. A drug in a lower tier will generally cost you less.
Quantity Limit Amount/Days: Certain drugs have a Quantity Limit. That means the plan will only cover the drug up to a designated quantity or amount. If your prescribing doctor feels it is necessary to exceed the set limit, he or she must get prior approval before the higher quantity will be covered.
Prior Authorization: Certain Drugs require you or your doctor to get prior authorization to be covered. Usually just an additional form. If you dont get approval, the plan may not cover the drug.
Does the Deduct Apply: Some drugs do not require that the deductible is met before you receive coverage.
Step Therapy: Means you must first try one drug to treat your medical condition before the plan will cover another drug for the same condition. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug.
Cost Preferred: Your Cost for the Drug at the Providers In-Network Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Non-Preferred: Your Cost for the Prescription Drug at a Non-Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Mail: Your Cost for Prescription Drugs through a Mail Order Pharmacy. As a Percent of the total drug cost or a flat rate.


What if a drug I need is not listed?

Please check the formulary for different brand and generic names. If you still cannot locate your drugs, your plan may not offer coverage. Talk to your doctor first about changing your prescription to a drug on your plan's formulary. If this is not an option, you can request an exception to have the plan review its coverage decision based on your individual circumstances.

Last updated on

Source:CMS Formulary Data Q4 2022
Source:NDC Directory by FDA.gov

**We make every attempt to keep our information accurate. But please check with the plan providers to verify all information.

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