MedicareBlue Rx Transition Policy

Overview

Each year MedicareBlue Rx provides a transition period that allows a temporary supply of Part D drugs so members can work with their prescribers on formulary alternatives, necessary prior authorizations, or formulary exceptions.

Who may be affected?

  • New members joining our drug plan at the beginning of a contract year
  • New members joining our drug plan after the beginning of a contract year
  • New members joining our drug plan who came from another Medicare Part D plan after the start of a contract year
  • Members who are currently enrolled with our plan and are changing to a new benefit plan within the same contract
  • Members residing in long-term care (LTC) facilities
  • In some cases, members affected by negative formulary changes (including new prior authorization or step therapy requirements) from one contract year to the next

The transition policy applies to:

  • Part D drugs not on the plan's formulary
  • Part D Drugs on a plan's formulary that require prior authorization or step therapy
  • Members who are effective as of November 1st or December 1st and were receiving a drug that was formulary, and beginning the new plan year the drug will be non-formulary

At the pharmacy, the transition policy provides at least a 30-day fill during the first 90 days in the plan where the member will pay:

  • The same for a non-formulary Part D drug in transition as they would for an approved formulary exception.
  • The same for a Part D drug with prior authorization or step therapy in transition as they would for the same drug without transition.

In a long-term care (LTC) setting, beginning on the member's effective date of coverage:

  • The transition policy provides multiple fills up to a 91 to 98 day supply
  • After the transition period has expired, a 31-day emergency supply of a transition-eligible Part D drug is available while a formulary exception or prior authorization is requested
  • Members being admitted to or discharged from a LTC facility are allowed to access a refill

See the full transition policy for complete details.

The Plan will send a written notice to the member and prescriber (upon use of a transition fill) including:

  • An explanation as to why the drug was only temporarily filled as a transition supply
  • Instructions for working with the plan and your prescriber
  • An explanation of the Member's right to request a formulary exception or prior authorization
  • A description of the process for requesting a formulary exception or prior authorization

Refer to the plan's transition policy for details.