Plan Drug Transition Policy

We have a transition plan in place for members who take medications that aren't covered by their plan’s formulary. A formulary is a list of medications that a plan covers.

 

If this situation applies to you, the first step is to talk to your doctor about whether you could switch to a medication that is covered by your plan. To give you and your doctor time to decide, our transition drug policy could allow your current medication to be covered during the first 90 days of your plan membership.

 

For each of your medications that isn't on our formulary, we'll cover a temporary 30-day supply (unless you have a prescription written for fewer days) when you go to a network pharmacy. After your first 30-day supply, we won't pay for these drugs, even if you have been a member of the plan less than 90 days.

 

If you're a resident of a long-term care facility, we'll allow you to refill a prescription until we have provided you with at least a 91-day supply. We'll cover more than one refill of these drugs for the first 90 days you're a member of our plan.

 

If you need a drug that isn't on our formulary or if your ability to get your drugs is limited, but you're past the first 90 days of membership in our plan, we'll cover a 31-day emergency supply of that drug (unless you have a prescription for fewer days). This will give you time to apply for a drug coverage exception.