Medicare Part D Medication Transition Process
HealthPartners medication transition process will provide transitional medications to:
- New enrollees to HealthPartners Medicare Part D plans on January 1 following the annual coordinated election period.
- Newly eligible Medicare beneficiaries from other coverage.
- The transition of individuals who switch from one plan to another after
January 1st. - Enrollees residing in long-term care (LTC) facilities.
- Enrollees residing in long-term care (LTC) facilities who have changes in level of care. For example, those entering an LTC facility or being discharged from a hospital.
- In this situation, early refills will be granted due to change in their level of care, when appropriate. HealthPartners will provide a one-time, temporary supply of a non-formulary Part D drugs in order to accommodate the immediate needs of an enrollee. Non-Formulary drugs include (1) Part D drugs that are not on the plan’s formulary, and (2) Part D drugs that are on the plan’s formulary but require prior authorization or step therapy.
This transition policy provides a one-time temporary 30-day fill at the retail setting (unless the enrollee presents a prescription written for less than 30 days) anytime during the first 90 days of the beneficiary's enrollment in a plan, beginning on the enrollee's effective date of coverage. Thirty days allows the plan and/or the enrollee sufficient time to work with the prescriber to either switch to a therapeutically equivalent medication on HealthPartners formulary or complete an exception request to maintain the coverage of the non-formulary drug based upon medical necessity reasons. If the prescription is written for less than 30 days or if safety quantity limits are in place, HealthPartners will provide a refill override to fulfill the 30-day requirement.
The cost sharing for the one-time transition will never exceed the enrollee's maximum copayment or coinsurance amounts and includes enrollee's low income subsidy amounts, if eligible. Cost sharing will be based upon the appropriate tier the non-formulary drug labeled meaning brand (single source) drugs will process under the brand copay when appropriate.
HealthPartners will send written notice to the enrollee within three business days of the transition fill indicating:
- An explanation of the temporary nature of the transition supply an enrollee has received.
- Instructions for working with the plan sponsor and the enrollee’s prescriber to identify therapeutic alternatives, when available and appropriate.
- An explanation of the enrollee’s right to request a formulary exception.
- Description of the procedures for requesting a formulary exception.
Enrollees residing in a LTC setting will receive a one-time temporary 31-day fill, unless the prescription is written for less than 31 days, with multiple fills as necessary, during the first 90 days of the beneficiary's enrollment with HealthPartners. In addition, HealthPartners will provide a one-time 31-day emergency supply of non-formulary drugs while an exception is being processed.
For more information
For more detailed information about your HealthPartners coverage, please review your Evidence of Coverage and other plan materials.
For questions you can call the numbers below between 8 a.m. to 8 p.m., seven days a week.
HealthPartners® Freedom Plan (Cost) members should call 952-883-7979 or
1-800-233-9645.
HealthPartners® Classic Plan (HMO) members should call 952-883-7676 or
1-866-233-8734.
HealthPartners® Classic MSHO Plan (HMO) members should call 952-967-7029 or
1-888-820-4285.
All TTY users should call 952-883-6060 or 1-800-443-0156.
If you have general questions about Medicare prescription drug coverage, please call
Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day/7 days a week.
TTY/TDD users should call 1-877-486-2048. Or visit www.medicare.gov.