Transition Supply Process
What if my current prescription drugs are not on the formulary or are limited on the formulary?
Under certain circumstances, IBX can offer a temporary transition supply of a drug to you when your drug is not on the Drug Formulary or when it is restricted in some way. Doing this gives you time to talk with your doctor about the change in coverage, while figuring out what to do. Please note that not all medications qualify for a transition supply.
You can also view our Transition Supply Policy.
IBX can only offer a temporary transition supply of drugs that are eligible for coverage under Medicare Part D. Drugs that are excluded from Part D coverage are not eligible for a transition supply.
For more information on excluded drugs, please reference your Evidence of Coverage (EOC).
For New Members
As a new member in our plan, you might currently be taking a drug that is not on our formulary. Or, the drug is on our formulary but your ability to get it is limited. In instances like these, you should talk with your doctor about appropriate alternative therapies available on our formulary. If there are no appropriate alternative therapies on our formulary, you or your doctor can request a coverage determination. If the exception is approved, you will be able to obtain the drug you are taking for a specified period of time. While you are talking with your doctor to determine your course of action, you may be eligible to receive an initial 30-day transition supply of the drug anytime during the first 90 days you are a member of our plan.
For each of your drugs that is not on our formulary, or for situations where your ability to get your drugs is limited, we will cover a temporary supply when you go to a network pharmacy. This temporary supply will be for a maximum of 30 days. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of 30-days of medication. After your first 30-day transition supply, we may not continue to pay for these drugs under the transition policy. You are reminded to discuss with your doctor appropriate alternative therapies on our formulary. If there are none, you or your doctor may request a coverage determination.
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, up to a maximum of 98 days of medication. If you need a drug that is not on our formulary, or if your ability to get your drugs 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 coverage determination.
For Continuing Members
If you already are a member in the plan, you should have received your Annual Notice of Change/Evidence of Coverage (ANOC/EOC) by September 30. You may notice that a formulary medication that you are currently taking is either not on the upcoming year's formulary or that coverage is limited in the upcoming year. In this case, we will provide a transition period consistent with the above transition process for new enrollees.
If you have any questions about our transition policy or need help asking for a coverage determination, call the Member Help Team at the number printed on the back of your ID card.
Website last updated: 1/1/2017
Y0041_HM_17_43499f Approved 1/6/2017