All stand-alone Part D plans and Medicare Advantage plans that include drug coverage must make transition refills available at the start of a plan year (January) or when someone is a new member of a plan. The transition refill is a one-time, 30-day supply of a Part D covered medication that is not covered on the plan’s formulary or that requires authorization to be covered by the plan.
Medicare Part D Plans can change their formularies each year and sometimes people do not realize that a medication they take is no longer covered or requires authorization to be covered until they try to get their medications refilled in the new year. The transition fill gives the Medicare beneficiary time to talk with her doctor and either seek a formulary exception, get prior authorization, or switch to a drug that the plan covers. Transition refills will not cover new medications people are prescribed.
When someone uses her transition refill, she should be told at the pharmacy that her medication was covered temporarily. Medicare beneficiaries in this situation should also quickly receive a letter from their Part D plan explaining that they have used their transition fill, why their prescription drug is not covered, and what their options are going forward.
People who need help getting their transition refill after January 1st can call the PA MEDI program at 1-800-783-7067.