Tips for Managing Transition Fills & Prior Authorizations to Save Pharmacies Time and Money

By: Wanda Lund, Product Lead, Net-Rx

Managing transition fill prescriptions and prior authorizations causes extra work for the pharmacy, can increase the pharmacy's transaction fees, and cause medication delays for the patient. However, pharmacies can benefit from proactively managing transition fills by working through prior authorizations and medication changes during the transition fill period. As we explain in this article, a proactive effort can save the pharmacy money on claims, reduce labor, and improve patient care.  

First, let's explore why there are transition fills in the first place and how to identify them.

A Medicare Part D Transition Supply is a temporary 30-day prescription supply or refill of a non-formulary drug 1 for: 

    • Patients who remain with the same Medicare Part D prescription plan into the next plan year but find their existing medications are no longer covered due to formulary changes.

    • Patients who joined a new Medicare Part D prescription drug plan during the open enrollment period and discovered their current medications are not covered under their new plan.

    • Patients who find their Medicare Part D prescription drug plan still covers their medication, but the plan now includes coverage restrictions, such as quantity limits, dosage form limits, prior    authorization, or step therapy requirements.

The Medicare Part D Transition Supply Policy provides patients with temporary coverage for prescription drugs they are currently taking. The transition policy is available to patients within 90 days of their enrollment in a new Medicare Part D plan or when their existing plan applies coverage restrictions or changes their drug formulary. ²  ... 

Read the full blog, here.