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. The process applies to:

• new enrollees to the prescription drug plan on January 1
• new enrollees to prescription drug plan on January 1 following the annual coordinated election period
• newly eligible Medicare beneficiaries from other coverage
• individuals who switch from one plan to another after January 1
• enrollees transitioning from one care setting to another e.g. Long-term (LTC) facilities.

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?

This means that you will be able to get, a one time temporary fill during the first 90 days of your enrollment in the new plan. This fill will be for up to a 30-day supply of your medication that you are currently taking, and that is not on your new plans formulary. You will also receive a notice by mail with in 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.