INSURANCE

Q: Have you ever heard of a transition refill for a prescription? Can I get one if my plan doesn’t cover my prescription?

A: Imagine this: You have been taking the same prescription medication for a couple of months. You are about to refill your prescription for the first time using your new Medicare Part D plan. When you go to pick up your prescription, the pharmacist tells you your drug is not covered by your Part D or Medicare Advantage plan.

In a situation like this, you may have the option of getting a transition refill (sometimes called a transition fill.) A transition refill provides you with temporary coverage for your prescription. It is typically a one-time, 30 day supply of the drug you are taking. All stand-alone Part D plans and Medicare Advantage Plans that provide drug coverage must provide transition refills if: 1. You recently switched plans and your medication is not on your new plan’s covered drug list 2. Your plan dropped your medication from its list of covered drugs

3. Your plan added coverage restrictions for the new calendar year, such as prior authorization or step therapy requirements.

Transition refills are only available for 90 days after enrolling in a new plan or after your plan made changes affecting your coverage. Transition refills are available for drugs you are already taking, not on new prescriptions. If your pharmacist provides you with a transition refill, you should contact your physician or health care provider as soon as possible to let them know you will not be permitted to refill your prescription under your current coverage. Your doctor will likely want to write a new prescription for a similar drug that is covered by your plan. In most cases, there is a different brand or a generic drug that will be covered.

If switching to a different drug is not a good option, you and your doctor can contact your plan to request a formulary exception. You also have the option of filing an appeal if your initial request for an exception is denied. For more information on transition refills, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-6334227). For information on Health and Life Insurance, including Medicare Supplements, Medicare Advantage Plans, Vision and Dental plans, call 440-255-5700 or email me at Lmutsko@mutskoinsurance.com.