Transition Requirements
•Enrollees initially enrolling in Part D, those switching plans, and current enrollees affected by formulary changes must receive coverage of at least a one-month fill (unless a lower amount was prescribed) of their non-formulary drugs during the first 90 days after their enrollment, the plan switch, or the formulary change.
•To the extent that a current enrollee in a long-term care setting is outside his or her 90-day transition period, the sponsor must still provide a one-month supply of nonformulary Part D drugs while an exception or prior authorization request is being processed.
•During the transition period:
o the Part D plan does not apply prior authorization or step therapy rules.
o the enrollee and his/her physician can request an exception to the Part D plan’s formulary to continue coverage of the non-formulary drug or can transition to a formulary drug.
