Prescription Drug Transition Process
UnitedHealthcare® Group Medicare Advantage
What to do if your current prescription drugs are not on the formulary or are restricted in some way.
As a new plan member, you may currently be taking drugs that are not on the plan’s formulary (drug list), or they are on the formulary but are restricted in some way.
In instances like these, start by talking with your doctor about appropriate alternative medications available on the formulary. If no appropriate alternatives can be found, you or your doctor can request a formulary exception. If the exception is approved, you may be able to obtain the drug for a specified period of time. While you and your doctor are determining your course of action, you may be eligible to receive a transition supply of at least a 1-month supply as described in your plan’s Evidence of Coverage of most drugs anytime during the first 90 days of membership in the plan. If the prescription is written for fewer days, multiple fills are allowed during the first 90 days until you’ve received at least a 1-month supply of your drug as described in your plan’s Evidence of Coverage. After your transition supply, these drugs may not continue to be covered.
If you live in a long-term care facility but you are past the first 90 days of plan membership, the transition program may cover at least a 31-day emergency supply of most drugs while you pursue a formulary exception.
You may face unplanned transitions after the first 90 days of plan enrollment, such as hospital discharges or level of care changes (i.e., changing long-term care facility or in the week before or after a long-term care discharge, end of skilled nursing facility stay and reverting to Medicare Part D coverage or when taken off of hospice care). For many drugs that are not on the formulary or your ability to get your drug is limited, you are required to use the plan’s exception process. You can request a one-time temporary supply of at least a 1-month supply as described in your plan’s Evidence of Coverage to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.
If you have any questions about this transition policy or need help asking for a formulary exception, a UnitedHealthcare representative can help.
Member/ Provider Guide to Care (PDF)(65.3 KB)
AT&T Understanding Medicare Guide (PDF)(1.8 MB)