Understanding the Transition Process

 

Current / Continuing Members

As a current member in the plan, you will receive your Annual Notice Of Change (ANOC) by October 1. You may notice that a formulary medication, which you are currently taking, is either not on the upcoming year’s formulary or its cost sharing or coverage is limited in the upcoming year.

In this case, you must work with your doctor to either find an appropriate alternative therapy on our new formulary or request a formulary exception prior to the beginning of the new year. If the exception request is approved, we will authorize payment.

For BCBSAZ members that move from one level of care to another as described below, BCBSAZ will provide a temporary, one time up to 30-day supply of a Part D eligible non-formulary medication. This one time fill needs to be authorized through the exception process. Therefore, your doctor or pharmacist will need to let MedImpact (at 800-788-2949) know that you are moving from one level of care to another.

Examples of moving (or transitioning) from one level of care to another include the following:

  • Members transitioning from hospital to home (discharge medications).
  • Members transitioning from a Skilled Nursing benefit (LTCF) and reverting to the Part D benefit.
  • Members terminating a Hospice election and reverting to Part A and Part D benefit.
  • Members discharged from a Chronic Psychiatric Hospital to home (discharge medications).

If you have any questions about our transition policy or need help asking for a formulary exception, call BCBSAZ.