A transition fill is typically a one-time, 30-day supply of a drug that your Part D plan must cover when you’re in a new plan or when your existing plan changes coverage. Transition fills let you get temporary coverage for drugs that are not on your plan’s formulary (list of covered drugs) or for drugs that have coverage restrictions on them. Coverage restrictions include prior authorization (your plan must approve the drug before it will cover it), step therapy (your plan requires you to try a cheaper, generic drug before it will cover a brand name or more expensive drug), and quantity limits (you can only get a certain amount of your prescription in a certain amount of time).
Transition fills are not for new prescriptions. You can only get transition fills for drugs you were already taking before switching plans or before your existing plan changed its coverage.
If your plan took your drug off of its formulary or added coverage restrictions for 2020, it must give you a 30-day transition fill within the first 90 days of the new calendar year, along with a notice that your drug is no longer covered. Note that if your plan helped you appeal for coverage of that drug or switch to a similar drug after telling you about the formulary change before January 1, 2020, then you will not qualify for a transition fill.
If you are new to a plan and the plan doesn’t cover a Medicare-covered drug you have been taking, or has coverage restrictions on your drug, you can get a 30-day transition fill within the first 90 days that you are enrolled in that plan.
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