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.

Woman in scarf outside

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.

 

Questions?

We’re here to help.  

HMO: (844) 918-0114 

PPO: (844) 915-0234 

TTY: 711 

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.