What should I do if I’m taking a drug that isn’t on the formulary or needs authorization?
Always talk to your doctor right away when you find out you take a drug that will not be on the formulary or one that requires prior authorization. If you are unable to change your drug to one on a formulary or obtain authorization in time, we will cover a temporary supply of eligible exception medications according to the following transition policy guidelines:
Eligible transition medications are those that:
Note: All transition medications must be obtained from a network pharmacy.
Note: Your cost for transition supplies will be at the highest drug cost-share (highest tier) under your plan. Tiering exceptions cannot be made for the cost of these transition medications.
The temporary transition supplies are provided in order to give you to time to talk to your doctor about switching to an appropriate formulary drug, obtaining authorization or requesting a formulary exception. Health First Health Plans will also send letters to members who were given a temporary supply. If you have any questions about this policy, please contact our Customer Service Department.
Y0089_MP3115 CMS Approved 10242012
Last updated: 10/1/2012