Medicare: What are Transition Refills?
I recently found out that my Medicare drug plan will no longer cover a drug that I need to take every day. What are transition refills?
A transition refill, also known as a transition fill, is a one-time, 30-day supply of a Medicare-covered drug that Medicare Part D plans, must cover within 90 days of when you are in a new Part D plan or when your existing Part D plan changes its coverage. Transition fills do not apply to new prescriptions. In order to get a transition fill, you must have been taking the drug before you switched your Part D plan or before your existing Part D plan changed its coverage rules.
For example, your Part D plan should allow you to get a 30-day transition fill of a drug if your Part D plan changed its coverage rules beginning January 1, 2014 and said that it will no longer cover a drug that you've been taking since 2013. You can get a one-time transition fill of the drug you need within the first 90 days of the year, i.e., up until the end of March.
Note that Part D plans are not allowed to apply Part D coverage restrictions, such as prior authorization or step therapy, to transition fill drugs. Prior authorization is a type of coverage restriction that requires you to get prior approval before your Part D plan will cover your drug. Step therapy is a type of coverage restriction that requires you to try similar, oftentimes cheaper, drugs before your Part D plan will cover the drug that you were initially prescribed.
In order to continue getting the drug you need throughout the year, you should contact your doctor right away. You may want to ask your doctor if you can switch to a similar drug that your Part D plan does cover. If your doctor does not recommend this due to medical reasons, ask your doctor if he/she can help you make a formal exception request to your Part D plan so that you can get the specific drug you need. Filing an exception request with your Part D plan is a way to formally ask y our Part D plan to cover the drug you need for the rest of the year or longer.