Prescription Drug Transition Policy

For Non-Long-Term Care Residents

For any drug that you are currently taking that is not on our formulary, or that requires additional authorization, we will cover a temporary 30‐day supply (unless you have a prescription written for fewer days, in which case multiple fills will be allowed to provide up to a total of a month’s supply of medication) anytime during the first 90 days of enrollment in a plan, beginning on the effective date of coverage when you fill the prescription at a network pharmacy. If you are given this temporary supply, please speak to your doctor before you use the entire supply so you and your doctor can select a formulary alternative or request an exception. We will not pay for this drug beyond your first 30‐day supply unless you have been approved for a formulary exception. 

For Long-Term Care Residents

If you are a resident of a long‐term care facility, we will cover a temporary transition supply up to 31 days during the first 90 days of enrollment beginning on the effective date of coverage.  If you need a drug that is not on our formulary, or is subject to additional authorization, but you are past the first 90 days of membership in our plan, we will cover up to a 31‐day emergency supply of that drug (unless you have a prescription for fewer days, in which case multiple fills will be allowed to provide up to total of a month’s supply of medication) while you pursue a formulary exception or work with your physician to select a formulary alternative.  

For Members Moving from Home to a Long-Term Care Facility or From a Long-Term Care Facility to Home

If your level of care changes (e.g., entering a long term‐care facility or going home after a stay in a long‐term care facility), Indiana University Health Plans provides transitional supplies of non‐formulary or otherwise restricted medications. For the first month after being discharged from a long‐term care facility, you can get at least a 31‐day supply of your current medications to allow time for you and your physician to switch to a formulary alternative or request an exception.  

For Current Enrollees

For drugs affected by negative formulary changes in the upcoming year, Indiana University Health Plan will provide meaningful transition by either: (1) providing a transition process at the start of the new contract year or (2) effectuating a transition prior to the start of the new contract year.