If your drug is not on the Formulary (drug list) or is restricted, you may be able to get a temporary supply of the drug in certain situations. This temporary supply is called a Transition Fill. A Transition Fill gives you time to talk with your doctor about a possible change in your prescription.
To be eligible, you must meet the two requirements below:
1. The change to your drug coverage must be one of the following:
- the drug you have been taking is no longer on the plan’s Formulary (drug list) OR
- the drug you have been taking is now restricted in some way
2. You must be in one of the situations described below:
- For those members who are new to the plan and are not in a long-term care facility - We will cover a temporary supply of your drug one time only during the first 90 days of your membership in the plan. This temporary supply will be for a maximum of 30-day supply, or less if your prescription is written for fewer days.
- For those who are new members, and are residents in a long-term care facility - We will cover a temporary supply of your drug during the first 90 days of your membership in the plan. The first supply will be for a maximum of 31-day supply, or less if your prescription is written for fewer days. If needed, we will cover additional refills during your first 90 days in the plan.
- For those who have been a member of the plan for more than 90 days, and are a resident of a long-term care facility and need a supply right away - We will cover one 31-day supply, or less if your prescription is written for fewer days. This is in addition to the above long-term care transition supply.
During the time when you are getting a temporary supply of a drug, you should talk with your doctor to decide what to do when your temporary supply runs out. Perhaps there is a different drug covered by the plan that might work just as well for you. Or you and your doctor can ask the plan to make an exception for you.