Getting Your Prescription Drugs

Under certain circumstances, you may be able to get a temporary supply of a drug when your drug is not on the Drug List or when it is restricted in some way. This gives you time to talk with your provider about your options. To be eligible for a temporary supply, you must meet the two requirements below:

1. The change to your drug coverage must be ONE of the following types of changes:
• The drug you have been taking is no longer in the formulary
• The drug you have been taking is now restricted in some way
2. You must be in ONE of the situations described below:
• Members who are new or who were in the plan last year and aren’t in a long-term care (LTC) facility: We will cover a temporary supply of your drug during the first 90 days of your membership in the plan if you were new and during the first 90 days of the calendar year if you were in the plan last year. This temporary supply will be for a maximum of a 30-day supply. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of a 30-day supply of medication. The prescription must be filled at a network pharmacy.
• Members who are new or who were in the plan last year and reside in a long-term care (LTC) facility: We will cover a temporary supply of your drug during the first 90 days of your membership in the plan if you are new and during the first 90 days of the calendar year if you were in the plan last year. The total supply will be for a maximum of a 98-day supply. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of a 98-day supply of medication. The long-term care pharmacy may provide the drug in smaller amounts at a time to prevent waste.
• Members who have been in the plan for more than 90 days and reside in a long-term care (LTC) facility and need a supply right away: We will cover one 31-day supply of a particular drug, or less if your prescription is written for fewer days. This is in addition to the above long-term care transition supply.

People with limited incomes may qualify for "Extra Help" to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, copays and/or coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty.

Many people are eligible for these savings and don’t even know it. For more information about this "Extra Help," contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

To find out more about Medicaid and its programs, contact:

The Medicare Prescription Payment Plan is a new payment option that works with your drug coverage, and it can help you manage your drug costs by spreading them across monthly payments that vary throughout the year (January – December). Find out more about this payment option here. You can also contact us at 1-866-845-1803/TTY 1-800-716-3231 or visit Medicare.gov/prescription-payment-plan.