Transition Fill

The transition process addresses situations where enrollees are stabilized on formulary drugs that require precertification or step therapy. It also addresses cases where a beneficiary changes their setting of care, such as a hospital to home or institutional setting).

The transition fill is offered to new enrollees in HMSA's Medicare Part D plan, as well as to existing Medicare Part D members making plan-to-plan changes within HMSA Medicare Part D plans.

Members who qualify for a transition fill may receive up to a 34-day supply within the first 90 days of eligibility. If the prescription is for less than 30 days, the member will qualify for refills up to 30 days (three 10-day supplies or two 15-day supplies).

HMSA's claim processor provides edits to pharmacies during claims adjudication for claims that qualify as a transition fill.

Call HMSA's pharmacy benefit manager for authorization.

Revision History