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:
- 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
- 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.
This webpage was updated on October 27, 2017.