Transition Drug Coverage
New to Mass Advantage? We’re here to help with the transition.
When you’re new to the plan, you might be taking a drug that’s not usually covered in our formulary. For times like these, we offer short-term, or “Transition,” coverage.
You can get Transition Drug Coverage when:
For example, you:
1. You’re new to Mass Advantage but are taking a drug that we don’t cover or that has coverage limits
See list of covered drugs and coverage limits
- During your first 90 days on the plan, we’ll cover up to a 30-day supply of your medication. If you live in a long-term care facility, we’ll cover a 31-day supply.
2. Your plan coverage changes
If coverage changes for a drug you take, we’ll tell you. Each year, you'll receive an Annual Notice of Change (ANOC) for your plan. It explains any coverage changes for the year ahead.
- If any changes affect one of your medications, we’ll cover a 30-day supply of the drug for the first 90 days of the new plan year.
- If you live in a long-term care facility, we’ll cover a 31-day supply.
3. You have a change in your level of care.
- Go home after a stay in a hospital or skilled nursing facility.
- Leave a long-term care facility and return to the community.
- You stop receiving hospice care.
For transitions like these, we’ll cover up to a 30-day supply of your medication. If you live in a long-term care facility, we’ll cover a 31-day supply.
More about Transition Drug Coverage
- We’ll send you a letter that confirms your transition coverage details.
- Once it ends, we can also work with your doctor to explore other options. For example, we can help you find a similar drug that’s covered and works just as well for you.
We’re here to help.
HMO: (844) 918-0114
PPO: (844) 915-0234
From October 1 to March 31, we’re available 7 days a week from 8am to 8pm EST. From April 1 to September 30, we’re available Monday through Friday from 8am to 8pm EST.