Sometimes, we will cover a short-term supply of a medicine you take that’s not on the Drug List. This usually happens when you join our plan and are taking medicines not on the Drug List. Or, you might be discharged from a hospital with medicines that are not on the Drug List (see more details below). Doing this gives you time to talk with your provider about the change in coverage and figure out what to do.
To be eligible for a temporary supply, these two things must be true:
- The medication you have been taking must be either:
- Not on our Drug List
- Was never on our drug List
- On our Drug List, but prior authorization or step therapy is needed
- You must be in one of these situations:
- You were in the plan last year. We will cover a temporary supply of your medicine during the first 90 days of the calendar year. This temporary supply will be for a maximum of 31 days. If the prescription is written for fewer days, multiple fills are allowed to provide the maximum limit of a 31-day supply. The prescription must be filled at a network pharmacy. Long term care pharmacies may provide your drug in small amounts at a time.
- You’re new to the plan. We will cover a temporary supply of your medication one time only during the first 90 days of your membership in the plan. This temporary supply will be for a maximum of 31 days. If your prescription is written for fewer days, multiple fills are allowed to provide the maximum limit of a 31-day supply. The prescription must be filled at a network pharmacy. Long term care pharmacies may provide your prescription in small amounts at a time.
- You’ve been in the plan for more than 90 days and live in a long term care facility and need a supply right away. We will cover one 31-day supply, or less if your prescription is written for fewer days. This is in addition to the above temporary supply.
- You have been in the plan for more than 90 days and your level of care has changed requiring you to transition from one facility or treatment center to another. You might be able to get a one-time (31-day) supply of your medicine.
- Were released from the hospital and given a list of discharge medicines based on the drug list the hospital uses
- Ended your stay at a skilled nursing facility covered by Medicare Part A (where payments include all pharmacy charges) and need to switch back to our plan’s Drug List
- Give up hospice status to switch back to standard Medicare benefits that you get under Cal MediConnect Part D
Please call Member Services to ask for your temporary supply.
Our transition policy applies only to:
- Part D medications and certain Medi-Cal Medicaid covered medications
- Medications purchased at a network pharmacy
While you’re getting a temporary supply of a medicine, talk with your provider to decide what to do when your medicine runs out. You can either:
- Switch to a different medicine covered by the plan
- Ask us to make an exception for you and cover the medicine you’re taking now
Need help understanding our temporary supply policy? Want to ask for an exception? We can help.
Call Member Services at 1-888-350-3447 (TTY: 711). We’re open Monday through Friday from 8 a.m. to 8 p.m. PST.