If you are a resident of a long-term care facility, we will cover a temporary 31-day transition supply (unless you have a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is not on our formulary or your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 31-day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary exception.
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 Advantage.