The pharmacy counter is not the place where you want to learn that a drug you’ve been taking is not covered by your Medicare Part D or Medicare Advantage plan. Yet it can happen. Fortunately, a prescription drug transition refill may be a remedy.
A transition refill, also called a transition fill, is a one-time, 30-day supply of a drug you’ve been taking that your plan doesn’t cover. Plans must provide a transition refill if one of these is true:
You recently switched plans and your medication is not on your new plan’s covered drug list (formulary).
Your plan dropped your medication from its formulary or added coverage restrictions for the new calendar year, such as prior authorization or step therapy requirements.
When Can I Get a Transition Refill?
You can get a transition refill up to 90 days after enrolling in a new plan or after your plan changes its coverage terms. Transition refills are only for drugs you were already taking. You can’t get one for a new prescription.
The pharmacy will tell you if you can get a transition refill when you go to refill your prescription. When you use your transition refill, your plan will send you a notice telling you that it’s temporary and explaining your options. You can only get one transition refill of your medication.
What Are My Options After I Use a Transition Refill?
You need to take action after using a transition refill, because you won’t be able to get your medication refilled again. You have two options:
Switch to a covered drug. Talk to your doctor to see if there’s a drug on your plan’s formulary that may work just as well for you as your current medication. It could be a different brand name drug or a generic. Your doctor will have to write you a new prescription.
File for a formulary exception. If you and your doctor believe you need the medication you’re taking, then your doctor can contact your plan to request an exception. The plan will review the request and grant or deny it. If it’s denied, you may file an appeal.
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