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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 2021 HAP covered drug list (PDF) or the 2022 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.
The transition policy applies to:
The following information applies to members who make use of our transition policy:
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2021 Health Alliance Plan of Michigan
Health Alliance Plan (HAP) has HMO, HMO-POS, PPO plans with Medicare contracts. HAP Empowered Duals (HMO SNP) is a Medicare health plan with a Medicare contract and a contract with the Michigan Medicaid Program. Enrollment depends on contract renewals.
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