Medicare Part D Transition Period Reverts to 30 days: CMS offers Transition Toolkit
The Medicare Part D benefit transition period, which was expanded from 30 to 90 days due to early program implementation problems, reverts to 30 days beginning April 1, 2006. The transition period allows new enrollees to Part D drug plans to receive a “first fill” supply of at least 30 days for medications that are not in a plan’s formulary. This transition supply of medications allows the beneficiary and his or her physician time to either replace the non-formulary drug with a therapeutic equivalent in the formulary or request a formulary exception from the plan. The Centers for Medicare and Medicaid Services (CMS) has also put together a transition toolkit that provides useful material for beneficiaries, physicians and their staff regarding the nature of drug plan formularies, the types of drug utilization management tools frequently employed by the plans (e.g. prior authorization, step therapy, quantity limits) and the exceptions/appeals process. The toolkit also includes an excellent slide presentation on these issues. The toolkit is available online.
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