What is a transition refill?

Helping patients adjust when coverage changes

At the beginning of a new plan year, Medicare Part D Prescription Drug plans are required to allow members a one-time, 30-day supply of a drug that they were taking that is no longer covered. This transition fill applies when members switch to a new plan with a different formulary, or when coverage changes at the start of the year—such as a drug being removed, requiring step therapy, or prior authorization.

The 30-day supply provides time for you to review alternatives with your patient or determine if an exception request should be completed.

Key reminders for providers

• Transition fills do not apply to new prescriptions.
• Members may obtain a transition refill up to 90 days after enrolling in a new plan or after a plan coverage change.
• Only one transition refill is allowed for the same drug during the 90-day window.
• You may receive an alert from Martin’s Point Pharmacy Administration with formulary alternatives. Review and either submit a new prescription or file an exception request.