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 on our formulary or has restrictions. To avoid disruption in your treatment, we provide a temporary supply through our transition drug coverage.
You are eligible for transition drug coverage when:
- You’re new to the plan and are taking a drug that we don’t cover or has restrictions
- You can get a transition fill during the first 90 days of joining our plan
- How we cover your drug is changing from one year to the next
- You can get a transition fill during the first 90 days of the new plan year
- You have a change in your level of care (e.g. you are admitted or discharged from a hospital or long-term care facility)
In all of these scenarios, we will provide up to a 30-day supply of medication (31-day if you live in a long-term care facility) of a drug that is not on our formulary or has coverage limits (e.g. requires prior authorization or has a quantity limitation).
After you receive a transition fill:
We will send you and your prescriber a letter to let you know that the drug you filled was a temporary supply. The letter will tell you what restrictions or limits apply to your drug. It will also tell you how to switch to another drug on our formulary or how to request we cover your drug.