Medicare Part D Transition Fills

As you know, federal policy required Medicare Part D plans to allow patients a “transition fill” of a non-formulary drug in order for the patient to have time to talk to their doctor and either switch to a formulary drug, or obtain a medical exception allowing them to stay on their non-formulary drug. This federal policy ends March 31, 2006. Beginning April 1, 2006, the transition fill overrides will no longer be in place for Medicare Part D beneficiaries.

While many patients have taken this opportunity to work with their doctor, others may not have understood the process, or may not have taken the opportunity to discuss their non-formulary drug with their physician. HFS would like to remind pharmacies that as patients present to fill prescriptions for drugs that the pharmacy was able to bill through their Part D plan through March, that same drug may now reject if the authorization is not in place.

HFS has reminded our Illinois Cares Rx coordinating plans to prepare for this date by making sure all help lines are alerted and that they have communicated to their network pharmacies. HFS would also like to remind pharmacies of this policy change as it will likely result in an increased volume of denials for non-formulary drugs.