Florida Health Care Plans'
Transition Policy for
Overview
For Medicare Part D members who are new to Florida Health Care Plans, we want to make your transition as seamless as possible. During the first 90 days of membership, we offer a temporary 30 day supply of medications to Medicare Part D members who:
• Are taking a Part D eligible Medication that is not on the formulary or
• Are taking a medication that is subject to certain restrictions such as Prior Authorization, quantity limits or step therapy.
Florida Health Care Plans Pharmacies will offer a temporary one-time fill for a Part D eligible non-formulary drug. The copay will be based on one of our Non-Preferred Brand or Specialty tiers. Transition supply copayments for members who have an L.I.S benefit (Low Income Subsidy) will not exceed the statutory maximums set by CMS for low-income Subsidy enrollees.
If you are a current member effected by a negative formulary change from one year to the next, we will provide a temporary supply of the non-formulary drug if you need a refill for the drug during the first 90 days of the new plan year at our an FHCP outpatient pharmacy or during the first 180 days of the new plan year for a long-term care facility. This 90 day period will extend across plan years for Members who enroll on November 1st or December 1st.
Florida Health Care Plans has also provided all new Medicare Enrollees with a Medicare Medication Transition From, which a clinical pharmacist will use to assist you Doctor in finding safe and effective formulary alternatives to a Non-Formulary Medication.
Who is eligible?
Newly eligible Medicare Part D participants or those enrolling from another plan during their first 90 days of membership.
What are the details of the long-term care facility transition policy?
Long Term Care Facilities (LTC) have an Open Formulary, Members who experience a transition in Care from a LTC to home will be eligible for a 30 day transition supply of medication.
What If there are no Medically Appropriate Formulary medications for my Non-Formulary medication?
You or your Doctor can contact the Member Services Department and Request an Exception to the Florida Health Care Plans Formulary. You or your physician will be asked to submit support clinical documentation.
How Can I or My Doctor get help finding a lower cost Formulary Medication?
Fill out the Medicare Medication Transition Form and send back to Florida Health Care Plans. The Form will be reviewed by a clinical pharmacist with experience in therapeutic interchange who will make recommendations to your Doctor regarding similar formulary medications. You or your Doctor may also speak with one of our clinical pharmacists Monday through Friday 8:30 am- 5:30pm, by contacting our Member Services Department.
