Part D Temporary Transition Supply

Under certain circumstances, the plan can offer a temporary supply of a drug when your drug is not on the Drug List or when it is restricted in some way.

To be eligible for a temporary supply, you must meet the two requirements below:

The change to your drug coverage must be one of the following types of changes:

• The drug you have been taking is no longer on the plan's Drug List.
• -- or -- the drug you have been taking is now restricted in some way

You must be in one of the situations described below:

• In the plan last year and not in a long-term care facility:
  

  We will cover a temporary supply of your drug one time only during the first 90 days of the calendar year. This temporary supply will be for a maximum of a 30-day supply or less if your prescription is written for fewer days. The prescription must be filled at a network pharmacy.

• New to the plan and not in a long-term care facility:
  

  We will cover a temporary supply of your drug one time only during the first 90 days of your membership in the plan. This temporary supply will be for a maximum of a 30-day supply, or less if your prescription is written for fewer days.

• New and a resident in a long-term care facility:
  

  We will cover a temporary supply of your drug during the first 90 days of your membership in the plan. The first supply will be for a maximum of a 31-day supply, or less if your prescription is written for fewer days. If needed, we will cover additional refills during your first 90 days in the plan.

• Member of the plan for more than 90days, a resident of a long-term care facility and need a supply right away:
  

  We will cover one a 31-day supply, or less if your prescription is written for fewer days. This is in addition to the above long-term care transition supply.

• Transferring from one treatment setting to another, such as moving from an inpatient hospital setting to home, called a level-of-care change. We will cover a temporary 30-day transition supply (unless you have a prescription written for fewer days). To ask for a temporary supply, call our Catalyst Rx Customer Service toll free number at 1-866-589-5222, or toll free TTY 1-888-206-8041. During the time when you are getting a temporary supply of a drug, you should talk with your doctor to decide what to do when your temporary supply runs out. Perhaps there is a different drug covered by the plan that might work just as well for you. Or you and your doctor can ask the plan to make an exception for you and cover the drug in the way you would like it to be covered. For information about making an exception request see the Evidence of Coverage, Chapter 9 , Asking for coverage decisions.