Sometimes, we will cover a short-term supply of a medicine you take that's not on the Drug List. Doing this gives you time to talk with your provider about the change in coverage and figure out what to do.
To be eligible for a temporary supply, these two things must be true:
1. The medication you have been taking must be either:
- Not on our Drug List
- On our Drug List, but is limited in some way
2. You must be in one of these situations:
- You were in the plan last year. You aren't in a long-term care facility.
We will cover a temporary supply of your medicine during the first 90 days of the calendar year. This temporary supply will be for a maximum of 30 days, or less if your prescription is written for fewer days. The prescription must be filled at a network pharmacy.
- You're new to the plan. You aren't in a long-term care facility.
We will cover a temporary supply of your medication one time only during the first 90 days of your membership in the plan. This temporary supply will be for a maximum of 30 days, or less if your prescription is written for fewer days. The prescription must be filled at a network pharmacy.
- You're new to the plan. You're in a long-term care facility.
We will cover a temporary supply of your medication during the first 90 days of your membership in the plan. We will allow multiple fills to provide a maximum of 98 days of medication.
We will cover a temporary supply of your medicine during the first 90 days of the calendar year. The total supply will be for up to a 91- to 98-day supply depending on the dispensing increment. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of a 98-day supply of medication. (Please note that the long-term care pharmacy may provide the drug in smaller amounts at a time to prevent waste.)
- You've been in a long-term care facility for more than 90 days and need a supply right away.
We will cover one 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.
- Your level of care has changed.
You might be able to get a one-time, short-term supply of your medicine if your level of care changes. That means you have to move from one facility or treatment center to another. We may cover this short-term supply after you've been a member for 90 days if you:
- Were released from the hospital and given a discharge list of medicines based on the drug list the hospital uses
- Ended your stay at a skilled nursing facility covered by Medicare Part A (where payments include all pharmacy charges) and need to switch back to our plan's Drug List
- Give up hospice status to switch back to standard Medicare parts A and B benefits that you get under Cal MediConnect
- Were discharged from a chronic psychiatric hospital with specific drugs you need for your condition
All of these are reasons we might cover a temporary one-time fill exception, even if you've been a member for more than 90 days.
Our transition policy applies only to:
- Part D medications and certain Medi-Cal covered medications
- Medications purchased at a network pharmacy
While you're getting a temporary supply of a medicine, talk with your provider to decide what to do when your medicine runs out. You can either:
- Switch to a different medicine covered by the plan
Search our Drug List for 2018 Plan
- Ask us to make an exception for you and cover the medicine you're taking now
Part D Transition Letter (PDF)
- This Transition Letter is in template form and will be changed for each Member’s specific situation. The letter provides details on each of the different notification reasons that one could receive.
Need help understanding our transition policy? Want to ask for an exception? We can help. Call Member Services at 1-888-350-3447 (TTY: 711). We're open Monday through Friday from 8 a.m. to 8 p.m. PST, except on holidays.