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Jan 3, 2017
JENNA K. FROM VIRGINIA ASKS: What's a transition refill?
Ryan Answers: The first trip to the pharmacy in January with a new insurance card in hand can be a little stressful for people who may not remember much about the plan they selected during Medicare’s open enrollment, which is Oct. 15 through Dec. 7 each year. Maybe you had a $400 deductible this past year, and the first month under your new plan will be more expensive. Maybe you will discover that your brand name medication suddenly requires a prior authorization from your doctor. There always seems to be something that makes the transition difficult. But thankfully, Medicare requires that new plans provide a transitional refill to prevent disruptions in therapy.
Some plans also require “step therapy,” or trying other medications first before “stepping up” to drugs that cost more. Medicare’s transition refill requirement makes sure your prescription is not disrupted by this insurance company requirement.
Medicare requires the plan to cover a 30-day supply of your medication and alerts the pharmacist that action needs to be taken. The pharmacist should then inform you that once your 30-day supply is exhausted, the plan will no longer cover the medication.
Once you are notified that your plan has provided you with a transitional refill, take action immediately to change the medication to a covered alternative, complete the step therapy or prior authorization paperwork, or complete a medication exception request form with the help of your doctor. If no action is taken, the plan will not cover the medication, and after your 30-day supply is exhausted you will be left paying the full cost of the medication.
Hopefully you or your insurance agent searched for your best plan options based on your current medication list, but sometimes a new medication is added after the Dec. 7 enrollment deadline.
Please call Medicare MarketPlace at 1-800-639-0781 to speak to a Licensed Insurance Agent if you are worried about how your medications will be covered in 2017 or if you’ve been notified that your medication requires a transitional refill. We can explore your options!
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