- prescription drugs
- Prescription Drug Transition Policy
Prescription Drug Transition Policy
We want to make sure you can get the medications you need. So there are times when you can get temporary coverage for drugs that your plan wouldn’t normally cover. This policy tells you when you can get that coverage and how it works.
When can I get temporary coverage?
You can get it in these 3 cases.
1. You’re new to Devoted and take a drug that we don’t cover or that has coverage limits.
During your first 90 days on the plan, we’ll cover up to a 30-day supply of your medication. If you live in a long-term care facility, we’ll cover a 31-day supply.
2. You’re an existing Devoted member and we change coverage for a drug you take.
Each year, you'll receive an Annual Notice of Change (ANOC) for your plan. It tells you about coverage changes for the upcoming year.
If these changes affect one of your medications, we’ll cover a 30-day supply of the drug during the first 90 days of the new plan year. If you live in a long-term care facility, we’ll cover a 31-day supply.
3. You have a change in your level of care.
Here are a few examples:
- You go home after a stay in a hospital or skilled nursing facility
- You leave a long-term care facility and return to the community
- You stop receiving hospice care
In cases like these, we’ll cover up to a 30-day supply of your medication. If you live in a long-term care facility, we’ll cover a 31-day supply.
How will I know it’s only a temporary supply?
When you pick up your prescription, the pharmacist may tell you that it’s a transition fill. That means you’re getting a temporary supply. If you use mail order, a pharmacist may call you to let you know. And either way, we’ll send you a letter so you’ll know for sure.
What are my options when the coverage ends?
It’s different for everyone. Be sure to talk to your doctor before your temporary supply runs out. That way, you’ll know our options. We may cover a different drug that works just as well for you. Or you and your doctor might decide to ask us if we can cover the drug in a different way.
If you have any questions, call us at 1-800-338-6838, TTY 711.