If you have a new Medicare Part D plan and have just found out that your new plan does NOT cover a drug you have been taking, you should know about transition refills. Transition refills may give you temporary coverage (one-time, 30-day supply) for a drug that is not on your new plan’s formulary OR that has restrictions (prior authorization or step therapy).
It is important to understand that a transition refill is only a temporary solution. You need to call your doctor right away to talk about switching to a drug your plan does cover OR filing a request with your Part D plan for a "formulary exception" (which may or may not be approved).
A transition refill is not for new prescriptions. You can only get one if you were already taking the drug before you signed up for the plan. Also, a transition refill does NOT apply to drugs that Medicare doesn’t require Part D plans to cover (like Valium and Ativan).
If you are in the same plan as last year, you may still be able to get a transition refill if your plan removed a drug you had been taking in 2012 from its 20123 formulary, for reasons other than safety.
Not all pharmacists know about transition refills. Ask your pharmacist to call your Part D plan for special instructions.
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