Each year Blue MedicareRx provides a transition period that allows a temporary supply of Part D drugs so members can work with their prescribers on formulary alternatives, necessary prior authorizations, or formulary exceptions.
Who may be affected?
- New members joining our drug plans at the beginning of a contract year
- New members joining our drug plans after the beginning of a contract year
- New members joining our drug plan who came from another Medicare Part D plan after the start of a contract year
- Members who are currently enrolled with our plan and are changing to a new benefit plan within the same contract
- Members residing in long-term care (LTC) facilities
- In some cases, members affected by negative formulary changes (including new prior authorization or step therapy requirements) from one contract year to the next
The transition policy applies to:
- Part D drugs that are not on the plan's formulary
- Part D Drugs that are on a plan's formulary but require prior authorization or step therapy
- Members who are effective as of November 1st or December 1st and were receiving a drug that was on the formulary, and beginning the new plan year the drug will no longer be on the formulary
At the pharmacy, the transition policy provides at least a 30-day fill during the first 90 days in the plan where the member will pay:
- The same for a non-formulary Part D drug in transition as they would for an approved formulary exception.
- The same for a Part D drug with prior authorization or step therapy in transition as they would for the same drug without transition.
In a long-term care (LTC) setting, beginning on the member's effective date of coverage:
- The transition policy provides multiple fills up to a 91 to 98 day supply
- After the transition period has expired, a 31-day emergency supply of a transition-eligible Part D drug is available while a formulary exception or prior authorization is requested
- Members being admitted to or discharged from a LTC facility are allowed to access a refill
See the full transition policy for complete details.
The Plan will send a written notice to the member and prescriber (upon use of a transition fill) including:
- An explanation as to why the drug was only temporarily filled as a transition supply
- Instructions for working with the plan and your prescriber
- An explanation of the Member's right to request a formulary exception or prior authorization
- A description of the procedures for requesting a formulary exception or prior authorization
Refer to the plan's transition policy for details.