Where to find 30 day transition fill rule info in Part D coverage

[yorkriver1]

Client who takes a drug not on their chosen plan's formulary and is willing to change to a different med on the formulary, needs to know about the 30 day transition fill.
It's not on the plan's EOC. 2023 plan. Lost Medicaid, signed up for a plan for 10/1/23 that has the most benefits like food card. Still has 75% LIS, but that doesn't help if RX not on the formulary.

 

[somarco]

A transition refill, also known as a transition fill, is typically a one-time, 30-day supply of a drug that you were taking:

Before switching to a different Part D plan (either stand-alone or through a Medicare Advantage Plan)
Or, before your current plan changed its coverage at the start of a new calendar year
Transition refills let you get temporary coverage for drugs that are not on your plan’s formulary or that have certain coverage restrictions (such as prior authorization or step therapy).
[EXTERNAL LINK] - Transition drug refills - Medicare Interactive

The Medicare Part D Transition Policy provides new enrollees immediate access to prescription drugs within 90 days of enrollment for non-formulary drugs and drugs with utilization management requirements.

The policy applies to Part D prescription drug plans and to Medicare Advantage plans that include prescription drug coverage.

The Medicare Part D Transition Policy exists to provide new (and some current) enrollees immediate access to prescription drugs within 90 days of enrollment for non-formulary drugs and drugs with utilization management requirements. The beneficiary should use the one-time, transition fill period to work with their doctor to decide whether it’s ok to switch to another drug the plan covers with no limitations on access, or to request a formulary exception. The policy applies to Part D prescription drug plans and to Part C Medicare Advantage plans that include Part D prescription drug coverage.
[EXTERNAL LINK] - The National Council on Aging

NOTE: Neither of these address losing Medicaid and transitioning to Part D. That may be the fly in the ointment

 

[yorkriver1]

Thanks, Bob, you always come through! I used RTM and searched the actual policy, AKA the Evidence of Coverage and found the 90 day mention as you outlined it.
For some reason my web searches didn't come up with what you found, maybe because I wanted to use Medicare's own words. Sometimes sites like Medicare Interactive are more informative.
PS for newer members of the forum
RTM = read the manual. Or for the salty, RTFM

 

[somarco]

I wanted to use Medicare's own words.

That is my preference as well, but I didn't find anything on Mcare.gov that specifically addressed your issue. Sometimes when I try to use dot gov I feel like I am using the automated answering services for companies . . . "Please listen carefully because our options have changed to better serve you".

Dot gov keeps changing things around. While the verbiage is "friendlier" it is almost impossible for me to find things. Searching for "medicare supplement guaranteed issue" used to take me right to the grid. Now I have to keep trying different search terms to find it.

The Medicare drug plan finder was easy to find but now it is buried deep in the site.

Bookmarking doesn't help because they keep moving pages around and restructuring them.

In an attempt to make the site more "user friendly" they have eliminated, or hidden, search results that answer your questions.