What is a transition fill?

Understanding temporary drug coverage changes under Medicare Part D.

A transition fill is a one-time, 30-day supply of a drug that Medicare Part D plans will cover for a medication that may no longer be covered by the plan or may have coverage requirements (some restrictions may apply). There are two reasons why you may receive a transition fill:

• 1. You recently switched prescription drug plans and your medication is not covered on your new plan’s formulary (list of covered drugs) or it now requires step therapy or a prior authorization for coverage.
• 2. Your plan changed coverage of your medication at the beginning of the new plan year. The medication could have been removed from the formulary, or now requires step-therapy or a prior authorization for coverage.

The 30-day window allows time for you to have coverage for the drug while you discuss with your provider if there is a suitable formulary alternative for the medication you are taking, or if your provider should submit a request for the plan to make an exception to allow continued coverage for the medication beyond the transition fill.

You can get a transition fill at any time during the first 90 days after enrolling in a new plan or after your plan changes its coverage. You can only get one transition fill in that 90-day window.

If you get a fill of an affected drug during the transition-fill 90-day window, you may receive a letter from the Martin’s Point Pharmacy Administration team advising you that it is not on the current formulary or has coverage restrictions. The letter will list formulary alternatives available to you.

Learn more: Visit our Medication Therapy Program & Transition Fills page for more details on eligibility and process.