New Members: Transition Coverage for Prescriptions
If you recently switched health plans, you may have learned the following about a prescription you started taking
before you joined CareAdvantage:
- Your drug is not covered by CareAdvantage because it is not in the formulary (list of covered drugs) or
- Your drug is covered, but with rules for prescription coverage
If you need a prescription that is not covered, you may be able to get 1 temporary refill. During the first 3
months of your enrollment in CareAdvantage, we may cover one temporary refill prescription for a drug that is not listed in our formulary.
The refill can be for a 31-day supply or less. Call the CareAdvantage Unit about getting a temporary
prescription. We will not pay for a second refill after covering one temporary refill.
If your covered prescription has rules that you do not agree with, your doctor can ask CareAdvantage to remove
the restrictions from your coverage. This is called making a formulary exception. Your doctor should call the
CareAdvantage Unit first, then fax a written statement that gives a medical reason for this request.