Online drug formulary

Choose a formulary:

How to choose a formulary

id cardStep 1: Check to see if the member has pharmacy benefits.

Whether or not the member has pharmacy benefits through Fallon Health depends on the plan he or she is enrolled in and/or the employer group he or she gets insurance through. The simplest way to check if a member has pharmacy benefits is to look at his or her health plan ID card. If the member has pharmacy benefits through Fallon, you'll see a CVS/Caremark logo on the front of the card.

Yes, there's a CVS Caremark logo on the ID card. No, there isn't a CVS Caremark logo on the ID card.
Member has pharmacy benefits through Fallon.
Go to step 2 below. ↓
Member doesn't have pharmacy benefits through Fallon.

Step 2: Find the member's plan name.

If the member has pharmacy benefits through Fallon, the next step is to find the member's plan name. You can find the plan name on the right side of the member's health plan ID card.

If the plan name is:

Fallon Senior Plan NaviCare MassHealth Companion Care, Direct Care, Select Care, Preferred Care, Tiered Choice or Steward Community Care
Choose "Fallon Senior Plan" from the pull-down menu at the top of the screen. Choose "NaviCare" from the pull-down menu at the top of the screen. Choose "MassHealth" from the pull-down menu at the top of the screen. Go to step 3 below. ↓

Step 3: Find the prescription copayments on the member's ID card

If the member has a Companion Care, Direct Care, Select Care, Preferred Care, Tiered Choice or Steward Community Care plan with pharmacy benefits, your next step is to find the prescription copayments on the member's ID card. Find the line that says "Prescription" on the bottom of the card.

If the "Prescription" line on the ID card shows:

3 different copay amounts 4 different copay amounts 4 different copay amounts, and the last amount has a "%" sign after it.
Choose "Commerical 3-Tier" from the drop-down menu at the top of the screen. Choose "Commerical 4-Tier" from the drop-down menu at the top of the screen. Choose "Premium Saver II 4-Tier" from the drop-down menu at the top of the screen.


If you need help choosing a formulary, call our Customer Service Department at 1-800-868-5200 (TTY users, please call TRS Relay 711), Monday, Tuesday, Thursday, and Friday from 8 a.m. to 6 p.m. and Wednesday from 10 a.m. to 6 p.m. MassHealth members can call Fallon Customer Service at: 1-800-341-4848. (TTY users, please call TRS Relay 711), Monday through Friday, 8 a.m. to 6 p.m.