What’s a transition fill?

Sometimes changes to your health plan can affect your prescriptions. For example: 

• You recently switched health plans, and your medication is not on your new plan’s covered drug list. 
• Your current plan has added new requirements, like prior authorization, step therapy, or limits on how much you can get at once. 

If this happens, we’re here to help. 

How does a transition fill work? 

For members with Part D coverage, a transition fill provides a one-time fill of your medication to give you time to talk with your doctor. Here’s how it works: 

• You’ll get a 30-day supply if you fill your prescription at a retail or mail-order pharmacy. 
• If you fill your prescription at a long-term care (LTC) pharmacy, you’ll get a 31-day supply. 

You don’t need to do anything special to get it. If your medication qualifies, the transition supply will automatically process when you pick it up at the pharmacy or receive it through the mail. 

Look out for a letter we will send you that will let you know you got a transition fill.  

If the pharmacist says your claim is denied, they won’t be able to provide you with the medication unless you want to pay for it in full. However, you may still be able to get your transition fill. You can call our Member Help Team for assistance, and they can assist you with what to tell your pharmacist. 

Who qualifies for a transition fill? 

To be eligible, you must be within the first 120 days of your plan’s start date. For example, if your plan starts on January 1, you’re eligible until April 30. 

Keep in mind: Even if you’re used to filling a 90-day supply, the transition fill covers only 30 or 31 days, depending on where you fill it. 

What’s covered? 

The transition supply is only available for: 

• Medications that are no longer on your plan’s formulary
• Medications that now need prior authorization or have quantity limits or step therapy

Examples of ineligible drugs include drugs changing from one tier to another, drugs covered under Part B, and drugs excluded from Medicare Part D for certain purposes. 

Once you get your transition fill, you will need to talk to your doctor about switching to another drug or get approval to continue taking your current one through an exception or prior authorization. Visit ibxmedicare.com/exception to learn about getting this approval.