What happens if a drug you take is not on the Formulary (drug list) or is listed as restricted in some way (such as needing Prior Authorization)?
You may be able to get a temporary supply of the drug if you qualify.
This temporary supply is called a Transition Fill. This allows you to continue taking your medication without interruption and gives you time to talk to your doctor. You and your doctor need to decide what to do when your temporary supply runs out. There may be a different drug that is covered by the plan that might work just as well for you which may cost less. Otherwise, you or your doctor can ask Senior Preferred to cover the medication that you are currently taking (a Coverage Determination Request may be submitted to start this process).
To be eligible for a Transition Fill, you must meet the two requirements below:
1. The change to your drug coverage must be one of the following:
- the drug you have been taking is no longer on the plan’s Formulary (drug list) OR
- the drug you have been taking is now restricted in some way
2. You must be in one of the situations described below:
- For those members who are new to the plan and are not in a long-term care facility - We will cover a temporary supply of your drug one time only during the first 90 days of your membership in the plan. This temporary supply will be for a maximum of 30-day supply, or less if your prescription is written for fewer days.
- For those who are new members, and are residents in a long-term care facility - We will cover a temporary supply of your drug during the first 90 days of your membership in the plan. The first supply will be for a maximum of 31-day supply, or less if your prescription is written for fewer days. If needed, we will cover additional refills during your first 90 days in the plan.
- For those who have been a member of the plan for more than 90 days, and are a resident of a long-term care facility and need a supply right away - We will cover one 31-day supply, or less if your prescription is written for fewer days. This is in addition to the above long-term care transition supply.
During the time when you are getting a temporary supply of a drug, you should talk with your doctor to decide what to do when your temporary supply runs out. Perhaps there is a different drug covered by the plan that might work just as well for you. Or you and your doctor can ask the plan to make an exception for you.
If you have questions, please contact Customer Service. You may also call through a video relay service company of your choice. Interpreter services are provided free of charge to you.
You can review the Senior Preferred Part D Drug Transition policy here.
This webpage was updated on October 1, 2019.