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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 HAP covered drug list (PDF), also known as a formulary or HAP Empowered Duals covered drug list (PDF) 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 Senior Plus 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:
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The following information applies to members who make use of our transition policy:
Copyright © 2018 HAP
2018 Health Alliance Plan of Michigan
Y0076_2019 HAP Website
CMS Accepted 10/1/2018
HAP Senior Plus (HMO)/(HMO-POS)/(PPO) and HAP Primary Choice Medicare (HMO) are health 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 in the plans depends on contract renewals. HAP Senior Plus (PPO) is a product of Alliance Health and Life Insurance company, a wholly owned subsidiary of HAP.
This information is not a complete description of benefits. For more information call Medicare Michigan customer service at (800) 868-9885 (TTY: 711) 8 a.m. to 8 p.m., seven days a week (Oct. 1 – March 31) / 8 a.m. to 8 p.m., Monday through Friday (April 1 - Sept. 30).
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