HAP

Temporary Medication Supplies

A Transition Process is used to provide a temporary supply of medication(s) for new enrollees
who are prescribed Part D drugs that are not on their current Part D plan’s formulary.

Who does the process apply to?

  • New enrollees into prescription drug plans (at the beginning of a contract year)
  • Newly eligible Medicare beneficiaries from other coverage (at the beginning of a contract year)
  • Individuals who switch from one plan to another (after the beginning of a contract year)
  • Enrollees residing in long-term care (LTC) facilities
  • Current enrollees affected by formulary changes from one contract year to the next
In the Retail setting, the transition process allows for a temporary fill of the non-formulary drug for up to a 30-day supply, during the first 90 days of your coverage under the new plan. The Part D plan will send a transition notice to the member who receives such a temporary fill within three business days by US mail.

What does this mean?

  • You will be able to receive a temporary fill during the first 90 days of your enrollment in the new plan.
  • You will be able to receive up to a 30-day supply of your medication that you are currently taking, that is not on your new plan’s formulary or is restricted by utilization management.
  • You will also receive a notice by mail within the first few days of your transition fill.
  • You should talk to your doctor so that you can be switched to a therapeutically equivalent drug that is on your current plan’s formulary, or request an exception.
In the LTC setting, the transition process allows for the temporary fill of the non-formulary drug in increments of a 31-day supply during the entire length of the 90-day transition period.

For more detailed information, read our complete Transition Policy.

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