Medicare Part D Medication Transition policy
HealthPartners medication transition policy will provide transitional medications to:
- New enrollees to HealthPartners Medicare Part D plans as of January 1st following the Annual Election Period.
- Newly eligible Medicare beneficiaries from other coverage.
- Individuals who switch from one plan to another after January 1st.
- Enrollees residing in long-term care (LTC) facilities.
- Enrollees residing in long-term care (LTC) facilities who have changes in level of care. For example, those entering an LTC facility or being discharged from a hospital. In this situation, early refills will be granted due to change in their level of care (when appropriate).
- Continuing enrollees affected by negative formulary changes from one contract year to the next.
One-time, temporary supply of non-formulary Part D drugs
HealthPartners will provide a one-time, temporary supply of non-formulary Part D drugs in order to accommodate the immediate needs of an enrollee. Non-formulary drugs include (1) Part D drugs that are not on the HealthPartners formulary and (2) Part D drugs that are on HealthPartners formulary but require prior authorization or step therapy (or that have an approved quantity limit lower than the beneficiary’s current dose) under HealthPartners utilization management rules.
One-time, temporary one month fill at retail setting
This transition policy provides a one-time, temporary fill of at least a month's supply of medication at the retail setting (unless the enrollee presents a prescription written for less than a month's supply in which case HealthPartners will allow multiple fills to provide up to a total of a month of medication) anytime during the first 90 days of the beneficiary’s enrollment in a plan, beginning on the enrollee’s effective date of coverage, or the first 90 days of the contract year for continuing enrollees. A month allows the plan and/or the enrollee sufficient time to work with the prescriber to either switch to a therapeutically equivalent medication on HealthPartners drug list or complete an exception request to maintain the coverage of the non-formulary drug based upon medical necessity reasons.
Cost sharing for the one-time transition
The cost sharing for the one-time transition will never exceed the enrollee’s maximum copayment or coinsurance amounts and includes enrollee’s low income subsidy amounts, if eligible. Cost sharing will be based upon the appropriate tier the non-formulary drug labeled, meaning brand drugs will process under the brand copay when appropriate.
HealthPartners will send written notice to the enrollee within three business days of the transition fill indicating:
- An explanation of the temporary nature of the transition supply an enrollee has received.
- Instructions for working with HealthPartners and the enrollee’s prescriber to identify therapeutic alternatives, when available and appropriate.
- An explanation of the enrollee’s right to request a formulary exception.
- Description of the procedures for requesting a formulary exception.
Enrollees residing in a LTC setting will receive a one-time temporary supply of at least a month's supply in increments of up to a month's supply, with multiple fills as necessary, during the first 90 days of the beneficiary’s enrollment with HealthPartners. In addition, HealthPartners will provide a one-time 31-day emergency supply of non-formulary drugs while an exception is being processed.
Last updated October 2019
H2462 H4882_118314 Accepted