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Transition Supply

Under certain circumstances, the plan can offer a temporary supply of a drug when your drug isn’t on the Drug List or when it is restricted in some way. Doing this gives you time to talk with your provider about the change in coverage and what to do. To be eligible for a temporary supply you must meet one of the below requirements:

  • You’re a new KelseyCare Advantage member.
    • You are eligible for a 30-day temporary supply of the medication within your first 90 days of enrollment.
    • If you reside in a long-term care facility, you’re eligible for a 31-day temporary supply of the medication within your first 90 days of enrollment.
  • You’ve recently been discharged from an inpatient hospital stay, long-term care facility, skilled nursing facility, or hospice.
    • You are eligible for a 30-day temporary supply of the medication.
    • If you reside in a long-term care facility, you’re eligible for a 31-day temporary supply of the medication.
  • Annual changes to the formulary have affected your drug coverage.
    • You are eligible for a 30-day temporary supply of the medication within the first 90-days of the plan year.
    • If you reside in a long-term care facility, you’re eligible for a 31-day temporary supply of the medication within the first 90-days of the plan year.

You will receive a letter from the plan after filling a temporary supply of the medication. It is important to keep this letter and discuss the contents with your provider to determine your next steps. For more information, you can view our transition policy or call Member Services for further assistance.

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