Prescription medications

Fallon Health Weinberg-HMO SNP covers many Part D prescription medications. They are listed on a Formulary/List of Covered Drugs. These drugs are chosen by doctors and pharmacists because they are effective and safe.

We cover brand name drugs and generic drugs. Generic drugs usually cost less but have the same active ingredients as brand name drugs.

Formulary drug list

2017 formulary

Use our 2017 online tool to see if a drug is covered

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See the whole formulary at once (pdf, H2470_W_2017_9_r1 Accepted 09202016, Formulary ID: 00017303, Version: 19, Last updated: October 26, 2017)

Please note: The printable formulary PDF above was last updated on October 26, 2017. It is subject to change at any time. For more information on the most recent list of drugs, see our online Part D drug formulary, or contact Fallon Health Weinberg at 1-855-561-7247 (TTY 711), 8 a.m.–8 p.m., Monday–Friday. (Oct. 1–Feb. 14, seven days a week.)

Formulary changes

You may view the addendum documents below to see any changes to the Fallon Health Weinberg-HMO SNP formulary. If there are no documents listed below, then there are currently no changes to the list of covered medications.

Formulary Addendum (Last updated October 26, 2017)

Prior authorization and step therapy

Prior authorization

For some drugs, your doctor needs to get approval (also called "prior authorization") from Fallon Health Weinberg. If you don’t get approval, Fallon Health Weinberg may not cover the drug. If a drug needs approval, you'll see a "PA" next to the drug name in the formulary. You can click on the "PA" symbol to see the approval rules for that drug.

Step therapy

Sometimes, Fallon Health Weinberg requires you to try a certain drug to treat your medical condition before we will cover another drug for that condition. This is called "Step Therapy." For example, if Drug A and Drug B both treat your medical condition, Fallon Health Weinberg may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Fallon Health Weinberg will then cover Drug B.

Drugs with step therapy requirements:

Fallon Health Weinberg is an HMO plan with a Medicare contract and a coordination of benefits agreement with the New York State Department of Health. Enrollment in Fallon Health Weinberg depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits may change on January 1 of each year. The Formulary may change at any time. You will receive notice when necessary.

To view the PDF files above, you may need to download a free copy of Adobe® Acrobat Reader software on your computer. (This link takes you away from the Fallon Health Weinberg website.)

H2470_W_2017_7 Approved 10182016

The information on this page was last updated on 10/1/2017.

Find a doctor

Looking for a doctor? Need to see if your current doctor is in our network?

Search online

Download the Provider and Pharmacy Directory (H2470_W_2017_26_r1_NM, pdf)

Contact us

Information before enrolling:
1-855-561-7248 (TTY 711)
8 a.m.–8 p.m., Monday–Friday
(Oct. 1–Feb. 14, seven days a week)

Customer Service:
1-855-561-7247 (TTY 711)
8 a.m.–8 p.m., Monday–Friday
(Oct. 1–Feb. 14, seven days a week)

Member information

2017 Summary of Benefits (H2470_W_2017_6_r1 Accepted 10152016) ►

2017 Evidence of Coverage (H2470_W_2017_1 Accepted 09122016, pdf) ►

About the Medication Therapy Management Program

Covered medications

Find a doctor

Medicare Part D forms

Request for Medicare Part D prescription drug coverage determination
Use this form to initiate a prior authorization request for your medication.

Request for a Medicare Part D appeal
Use this form to initiate an appeal for a denied medication.