What is a Transition Refill?

Dear Marci, A drug that I need to take is not on my Part D prescription drug plan’s formulary. My friend told me that my plan might need to provide me with a transition refill of this prescription. What does this mean?

- Ezra (Portland, OR)

Dear Ezra, A transition refill, also known as a transition fill, is a one-time, 30-day supply of a drug that you were taking:

• Before switching to a different Part D plan (either stand-alone or through a Medicare Advantage Plan)

• Or, before your current plan changed its coverage at the start of a new calendar year. Transition fills let you get temporary coverage for drugs that are not on your plan’s formulary or that have certain coverage restrictions (such as prior authorization or step therapy).

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.

The following situations describe when you can get a transition refill if you do not live in a nursing home (there are different rules for transition refills for those living in nursing homes):