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Transition policy

We provide a transition process consistent with 42 CFR §423.120(b)(3), which deals with access to covered prescription drugs under Medicare Part D.

The process includes a written description of how enrollees whose current drug therapies may not be included in the 2024 HAP covered drug list (PDF), also known as a formulary, may receive a temporary supply of a nonformulary drug, as well as Part D drugs that are on the formulary but require prior authorization, step therapy or are subject to quantity limits under the HAP Medicare utilization management rules.

A meaningful transition period allows sufficient time for members to work with their health care provider to select an appropriate formulary alternative or to request a formulary exception based on medical necessity.

Transition policy eligibility

The transition policy applies to:

  • New enrollees into prescription drug plans at the beginning of a contract year
  • The transition of newly eligible Medicare beneficiaries from other coverage at the beginning of a contract year
  • The transition of individuals who switch from one plan to another after the beginning of a contract year
  • Enrollees residing in long-term care facilities
  • Current enrollees affected by formulary changes from one contract year to the next

Transition policy facts

The following information applies to members who make use of our transition policy:

Health Alliance Plan (HAP) has HMO, HMO-POS, PPO plans with Medicare contracts. HAP Medicare Complete Duals (HMO D-SNP) is a Medicare health plan with a Medicare contract and a contract with the Michigan Medicaid Program. Enrollment depends on contract renewals.