Transition Process

Whether you are a new or continuing member, our transition process provides for smooth adjustment to plan requirements and changes.

New members

If, prior to joining one of our plans, you have been taking a drug we don’t cover, we will provide for temporary coverage. You can get a 30-day initial supply of the drug at a network pharmacy anytime during the first 90 days of your plan membership. After that, we might not continue to cover the drug, but we will send you a written notice to confirm this.

This transition plan also applies to drugs you have been taking that have requirements such as prior authorization, quantity limits, or step therapy. As a new member, you can get an initial 30-day transition supply of these drugs at a network pharmacy.

Renewing and continuing members

If a change to our drug list affects a drug you take, we’ll cover up to a 30-day refill during the first 90 days of the new plan year. After that, we generally won’t cover another supply of the same drug. This transition plan also applies to drugs that have restrictions such as prior authorization, quantity limits, or step therapy. To confirm this, we will send you a written notice.

Long-term care residents (both new and continuing members)

If you live in a long-term care facility, we’ll cover up to a 31-day transition supply of drugs you’ve been taking. This applies whether you’re new to our plans or are affected by a change to our drug list. In addition, we’ll continue to cover drug refills for the first 90 days of your plan membership.

If you’re past the first 90 days of membership, we’ll cover up to a 31-day emergency supply of a drug you’ve been taking. To get coverage after that, you and your doctor must request an exception by completing a Coverage Determination Request Form available under documents.

Talk to your doctor

In cases where we don’t cover a drug you’ve been taking, you should talk with your doctor about switching to an alternative drug we do cover. If your doctor believes there are no appropriate alternatives on our drug list, you can request an exception by completing a Coverage Determination Request Form available under documents. If the exception is approved, we will provide coverage for the drug you need for a specified period of time.

Please contact Blue MedicareRx (PDP) for a printed version of our pharmacy directory or additional information.

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