Mental Health Part D News Alert

January 3, 2006

Current PDP Transition Plans, by State

As of January 1, 2006 , Medicare Part D prescription drug plans across the nation have begun providing prescription drug benefits to millions of Americans. Guidance from the Centers for Medicare and Medicaid Services (CMS) requires that the PDPs develop transition plans for individuals switching their coverage to Medicare Part D.

Click here to view a chart of current transition plans of PDPs, organized by state. The chart lists the transition refill policy for each PDP, for both new enrollees and long-term care residents.

Specifically, CMS requires that a PDP’s transition process “address situations where an individual first presents at a participating pharmacy with a prescription for a drug that is not on the formulary, unaware of what is covered by the plan or what is included in the plan’s exception process to provide access to Part D drugs that are not covered.”  PDPs are to consider “processes such as the filling of a temporary one-time transition supply in order to accommodate the immediate need of the beneficiary and to allow the plan and/or the enrollee time to work out with the prescriber an appropriate switch to another medication or the completion of an exception request to maintain coverage of an existing drug based on reasons of medical necessity.”  CMS has suggested that a first-fill supply of 30 days would be a reasonable standard.