Prescription Drug Transition Policy

Transition Policy on Prescription Drugs

As a new or continuing member, you may be taking drugs that are not on our Part D Formulary or on our Part D Formulary and require a prior authorization or are step therapy and/or have quantity limits.

In these instances, talk to your doctor about choosing the right alternative medications or therapies available on our Part D Formulary. If there are no appropriate alternative therapies on our Part D Formulary, you or your doctor can request an exception and ask the Plan to cover the drug or remove restrictions from the drug.

While you are talking with your doctor to determine the course of action, we may cover up to a 30-day transition supply of Part D drugs that are not on our Part D Formulary or on our formulary and require a prior authorization or are step therapy and/or have quantity limits during your first 90 days of coverage.

Transition Policy for Long-Term Care Facility

If you are a resident of a long-term care facility, we may cover at least a 91-day and up to a 98-day transition supply, depending on the dispensing increment, during the first 90 days of coverage. After the first 90 days, we may also provide a 31-day emergency supply unless you have a prescription written for fewer days.

Transition Policy for Level of Care Change

If you are a member with a level of care change, we may cover a 31-day transition supply if you are moving from home or a hospital stay to a long-term care facility. We may cover a 30-day transition supply if you are moving from a long-term care facility or a hospital stay to home.

If you have any questions about our transition policy or need help asking for a formulary exception, please call Brand New Day at the contact listed below.