Prescription Drug Transition Process | AARP® Medicare Plans from UnitedHealthcare®
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Prescription Drug Plans

Prescription Drug Transition Process

What to do if your current prescription drugs are not on the Drug List or are restricted in some way.

 

New Members

As a new member of an AARP® MedicareRx plan, insured through UnitedHealthcare, you may currently be taking drugs that are not on the plan's formulary (drug list) or are on the formulary but coverage is restricted in some way.

Under certain circumstances, you may be able to get a temporary supply of your prescription drug. This will give you and your doctor time to change to another drug or request an exception and ask the plan to cover the drug or remove restrictions from the drug. If the exception is approved, you will be able to obtain the drug you are taking for the specified period of time.

While you are talking with your doctor to determine your course of action, you are eligible to receive at least a 30-day temporary supply (unless you have a prescription written for less than 30 days) when you go to a network pharmacy. If your prescription is written for fewer than 30 days, we will allow multiple fills to provide at least 30 days of drugs.

After your first 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 the plan's Drug List and if there are none, you or your doctor can request an exception.

If you are a resident of a long-term care facility, we will cover at least a temporary 31-day supply (unless you have a prescription written for less than 31 days). We will cover more than one refill of these drugs for the first 90 days you are a member of our plan, for at least a 98-day supply. If you need a drug that is not on our formulary or your ability to get drugs is limited, but you are past the first 90 days of membership in our plan, we will cover at least a 31-day emergency supply of that drug (unless you have a prescription for less than 31 days) while you pursue a formulary exception.

There may be unplanned transitions such as hospital discharges or level of care changes (i.e., changing long-term care facility or in the week before or after a long-term care discharge, end of skilled nursing facility stay and reverting to Medicare Part D coverage or when taken off of hospice care) that can occur after the first 90 days that you are enrolled as a member of our plan. If you are prescribed a drug that is not on the Drug List or coverage is restricted in some way, you may request a one-time emergency supply of at least 30 days (unless you have a prescription written for less than 30 days) to allow you time to discuss alternative treatment with your doctor or to pursue an exception. This is in addition to the above long-term care transition supply.

 

Continuing Members

As a continuing member in the plan, you receive an Annual Notice of Change (ANOC). This will tell you about any change in the coverage for your drug for next year.

Starting October 15, 2016, you may request a 2017 coverage review. If your request is approved, the plan will cover the drug as of January 1, 2017.

If a drug you are taking will be removed from the formulary or restricted in some way for next year and you have not discussed with your doctor to switch to an alternative formulary medication or pursued a formulary exception, you may receive at least a 30-day temporary supply of your drug as of January 1, 2017, (unless you have a prescription for less than 30 days), when you go to a network pharmacy, to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.

If you live in a long-term care facility, you may receive at least a 31-day supply of the transition eligible medication and can obtain multiple refills for at least a total of a 98-day supply, including when prescriptions are dispensed for less than the written amount due to drug utilization edits that are based on approved product labeling.

There may be unplanned transitions such as hospital discharges or level of care changes (i.e., changing long-term care facility or in the week before or after a long-term care discharge, end of skilled nursing facility stay and reverting to Medicare Part D coverage or when taken off of hospice care) that can occur anytime. If you are prescribed a drug that is not on our Drug List or coverage is restricted in some way, you are required to use the plan's exception process. You may request a one-time emergency supply of at least 30 days (unless you have a prescription written for less than 30 days) to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.

If you have any questions about our transition policy or need help asking for a formulary exception, please contact UnitedHealthcare Customer Service.

Para ver el Comprobante de Cobertura y otros materiales de Medicare de medicamentos recetados del plan, ingrese a Ver planes y precios y siga los pasos para ver los planes disponibles.

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