Pharmacy transition process

Temporary coverage of drugs not on formulary

As a new or continuing member with a Dean Advantage plan, you may be taking drugs that are not on our formulary. Or you may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription.

Talk to your doctor to see if you need to switch to a covered drug or request a formulary exception to cover your current prescription. In some cases, we may cover a drug not on our formulary for the first 90 days of your plan membership. This will give you time to work with your doctor to determine what's best for you.

Limited access

If your drugs are not on our formulary, or if your drugs are not available, we may cover a temporary supply (up to 30 days) when you go to a network pharmacy. After your first 30-day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days.

Long-term care facility residents

If you are a resident of a long-term care facility, we'll allow you to refill your prescription until we've provided you with a 31-day transition supply, consistent with the dispensing increment (unless you have a prescription written for fewer days). We'll cover more than one refill of these drugs for the first 90 days you're a member of our plan. If you need a drug that's not on our formulary, or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we'll cover a 31-day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary exception.

Change in level of care

If you experience a change in your level of care, such as a move from a hospital to a home setting, and you need a drug that's not on our formulary or if your ability to get your drugs is limited, we'll cover a one-time temporary supply for up to 30 days (or 31 days if you are a long-term care resident) when you use a network pharmacy. During this period, you should use the plan's exception process if you wish to have continued coverage of the drug after the temporary supply is finished.