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Get a Temporary Supply of Prescription Drugs

Information Last Updated: 11/13/2018

HOW TO GET A TEMPORARY SUPPLY OF DRUGS (TRANSITION FILL)

 

You may be able to get a temporary supply (Transition fill)

Under certain circumstances, the plan can offer a temporary supply of a drug to you when your drug is not on the Drug List or when it is restricted in some way. Doing this gives you time to talk with your provider about the change in coverage and figure out what to do. To be eligible for a temporary supply, you must meet the two requirements below:

1. The change to your drug coverage must be one of the following types:

The drug you have been taking is no longer on the plan’s covered medications list or the prescribed 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 were in the plan last year and aren’t in a Long-Term Care (LTC) facility:

We will cover a temporary supply of your drug during the first 90 days of the calendar year. This temporary supply will be for a maximum of a 30-day supply. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of a 30-day supply of medication. The prescription must be filled at a network pharmacy.
 

For those members who are new to the plan and aren’t in a Long-Term Care (LTC) facility:

We will cover a temporary supply of your drug during the first 90 days of your membership in the plan. This temporary supply will be for a maximum of 30-day supply. If your prescription is written for fewer days, we allow multiple fills to provide up to a maximum of a 30-day supply of medication. The prescription must be filled at a network pharmacy.
 

For those members who were in the plan last year and reside in a Long-Term Care (LTC) facility:

We will cover a temporary supply of your drug during the first 90 days of your membership in the plan. The total supply will be for a maximum of a 98-day supply. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of a 98-day supply of medication. (Please note that the long-term care pharmacy may provide the drug in smaller amounts at a time to prevent waste.)
 

For those members who are new to the plan and reside in a Long-Term Care (LTC) facility:

We will cover a temporary supply of your drug during the first 90 days of your membership in the plan. The total supply will be for a maximum of 98-days. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of 98-days of medication. (Please note that the Long-Term Care pharmacy may provide the drug in smaller amounts at a time to prevent waste.).
 

For those members who have been in the plan for more than 90 days and reside in a Long-Term Care (LTC) 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.
 

For those members who have been in the plan for more than 90 days and have a level of care change:

We will cover a temporary supply for up to 30 days, or less if your prescription is written for fewer days even if the drug is not on our formulary or the drug is subject to certain restrictions such as prior authorization or step therapy. The drug must be a Part D covered drug. The prescription must be filled at a network pharmacy.
 

We will send you a letter after we cover a temporary supply of drugs.

We will provide you with a written notice after we cover a temporary supply. This notice will explain the steps to request an exception and how to work with the provider to switch to an appropriate drug that we cover. After we cover the temporary 30-day supply, we may not pay for the drug again as part of our transition policy.

To ask for a temporary supply, call Brand New Day Member Services.

Member Services Department Contact Information

Call: 1-866-255-4795
TTY: 711
Hours of Operation: Year Round: Monday – Friday, 8:00 a.m. – 8:00 p.m.
October 1 – March 31: 7 days a week, 8:00 a.m. – 8 p.m.
Calls to these numbers are free.

During the time when you are getting a temporary supply of a drug, you should talk with your provider to decide what to do when your temporary supply runs out. You can either switch to a different drug covered by the plan or ask the plan to make an exception for you and cover your current drug.

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