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Part D Temporary Transition Supply

Under certain circumstances, the plan can offer a temporary supply of a drug when your drug is not 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 the two requirements below:


1. The change to your drug coverage must be one of the following types of changes:

  • The drug you have been taking is no longer on the plan's Drug List
  • Or the drug you have been taking is now restricted in some way


2. You must be in one of the situations described below:

  • For those members who are new or who were in the plan last year and aren’t in a long-term care (LTC ) facility:
    We will cover a temporary supply of your drug during the first 90 days of your membership in the plan if you were new and during the first 90 days of the calendar year if you were in the plan last year. If your prescription is written for fewer than 30 days, we’ll allow multiple fills to provide up to a maximum of 30 days of medication. The prescription must be filled at a network pharmacy.
     
  • For those members who are new or who were in the plan last year and reside in a long-term care (LTC) facility:
    We will cover a temporary supply of your drug during the first 90 days of your membership in the plan if you are new and during the first 90 days of the calendar year if you were in the plan last year. If your prescription is written for fewer than 31 days, we’ll allow multiple fills to provide up to a maximum of 31 days of medication. (Please note that the long-term care pharmacy may provide the drug in smaller amounts at a time to prevent waste.)
     
  • Member of the plan for more than 90 days, a resident of a long-term care facility and need a supply right away:

    We will cover a 31-day supply, or less if your prescription is written for fewer days. This is in addition to the above long-term care transition supply.
     
  • Transferring from one treatment setting to another, such as moving from an inpatient hospital setting to home, called a level-of-care change. We will cover a temporary 30-day transition supply or a 31-day transition supply if you reside in a long-term care facility (unless you have a prescription written for fewer days).

    To ask for a temporary supply, call our ​OptumRx Customer Service toll free number at 1-866-589-5222, or toll free TTY 1-888-206-8041.

    During the time when you are getting a temporary supply of a drug, you should talk with your doctor to decide what to do when your temporary supply runs out.  You can either switch to a different drug covered by the plan or ask the plan to make an exception for you and cover your current drug. For information about making an exception request see the Evidence of Coverage, Chapter 9 , Your Part D Prescription Drugs: How to ask for a coverage decision or make an appeal.

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