This policy describes the transition requirements published by the Centers for Medicare and Medicaid Services (CMS), which state that all Part D sponsors must provide an appropriate transition benefit for members. For questions about this policy, please call the phone number on the back of your member ID card.
This policy covers the following:
- Eligible members
- Applicable drugs
- New prescriptions versus ongoing drug therapy
- Transition time frames
- Transition extensions
- Transition across contract years for current members
- Emergency supply for current members
- Treatment of re-enrolled members
- Level of care changes
- Transition notices
This policy describes how transition benefits apply when you are filling prescriptions in:
- Long-term care (LTC) settings
- Retail pharmacies
- Extended supply network (ESN) (90 days of retail setting)
- Mail order pharmacies