Prescription Drug Transition Policy
Before you talk to your doctor about changing your drugs or requesting an exception, review the following important information about our prescription drug transition policy:
- As a new or continuing member in our plan, you may be taking drugs that are not on our drug list (which is also called the formulary).Alternatively, you may be taking a drug that is on our formulary, but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription.You should talk to your doctor to decide if you should switch to an appropriate drug that we cover, or if you should request a formulary exception so that we will cover the drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your drug up to a 30-day supply in certain cases during the first 90 days in which you are a member of our plan.
- For each of your Part D drugs not on our formulary or if your ability to get your Part D drugs is limited, we maycover a temporary 30-day supply (unless you have a prescription written for fewer days) when you use a network retail pharmacy or home infusion pharmacy.
- After your initial 30-day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days.
- If you are a resident of a long-term care facility, we may cover a temporary 91-day transition supply up to a 98-day transition supply (unless you have a prescription written for fewer days) for the first 90 days you are a member of our plan.
- For residents of a long term care facility who need a Part D drug that is not on our formulary or if the ability to get drugs is limited, please note the following: If you are past the first 90 days of membership in our plan, we may cover a 31-day emergency supply of that Part D drug (unless you have a prescription for fewer days) while you pursue a formulary exception. Medications obtained at retail, mail order, Indian tribal or home infusion pharmacies are eligible for this transition policy.