As a new or continuing member of our plan, you may be taking drugs that are not on our formulary. Or you may be taking a drug that is on our formulary, but your ability to get it may be limited. For example, you may need prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to another drug we cover or request a formulary exception in order for us to cover the drug you currently take. To give you time to speak to your doctor about the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan.
For each of your drugs that is not on our formulary, or if your ability to get your drugs is limited, we will cover a temporary 30-day supply when you go to a network pharmacy (unless you have a prescription written for fewer days). After your first 30-day supply, we will not pay for these drugs, even if you have been a member for fewer than 90 days. Other conditions may also apply.
If you are a resident of a long-term care facility, we will cover a temporary 31-day transition supply, consistent with dispensing increment (unless you have a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is not on our formulary and you are past the first 90 days of membership in our plan, we will cover up to a 31-day emergency supply of that drug while you pursue a formulary exception.