Drug Transition Policy
In some cases, CareSource must provide a temporary supply of a drug that you are already taking. This is known as a transition refill, or temporary supply. The transition refill can be up to a 30-day supply at a network pharmacy if one of the following is true:
- You are new to CareSource Dual Advantage in the first 90 days of your membership and your medication is not on our covered drug list (formulary) or coverage is limited in some way, such as prior authorization, step therapy, or quantity limit.
- If CareSource dropped your medication from the formulary or added coverage restrictions for the new calendar year, such as prior authorization or step therapy, we will cover a temporary supply during the first 90 days of the calendar year.
- If you have been with CareSource Dual Advantage for more than 90 days and reside in a long-term care facility and need a supply right away, we will cover one 31-day emergency supply of a drug. This is in addition to the temporary supply.
- If you have an unplanned transition during the plan year, we may cover a one-time temporary supply of your drugs up to a 31-day supply. An unplanned transition happens when you change treatment settings such as being discharged from the hospital to home or ending your skilled nursing facility stay.
When you receive a transition refill, your plan will send you a notice telling you it is temporary and explaining your options. When you are using a temporary supply of a drug, you should talk with your provider to decide what to do when your temporary supply runs out. You have two options:
- You can change to another drug. Talk with your provider about whether there is a different drug covered by the plan that may work just as well for you.
- You can ask for an exception. You and your provider can ask the plan to make an exception and cover the drug in the way you would like it covered. The plan will review the request and approve or deny. If denied, you may file an appeal.
For questions about a temporary supply, please review your Evidence of Coverage on the Plan Documents page or call Member Services at 1-833-230-2020 (TTY: 1-833-711-4711 or 711). We are open 8 a.m. to 8 p.m. Monday through Friday, and from October 1 through March 31 we are open the same hours, seven days a week.