Plan Transition


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If you experience an unplanned transition from one treatment setting to another (like entering a long-term care facility) you may be taking drugs that are not on our formulary but require prior authorization, step therapy or quantity limits. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are in a different treatment setting.

  • If you are a resident of a long-term care facility, we will cover a temporary 31-day transition supply (unless you have a prescription written for fewer days).
  • We will cover more than one refill of these drugs for the first 90 days you are a member of our plan.
  • If you need a drug that is not on our formulary or if your ability to get your drug is limited, but you are past the first 90 days of membership in our plan, we will cover a 31-day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary exception.

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Plan Transition en Español