Transition Process

TRANSITION PROCESS

TRANSITION PROCESS


In some cases, MeridianComplete can give you a temporary supply of a drug when the drug is not on the Drug List (Formulary) or when it is limited in some way. This gives you time to talk with your provider about getting a different drug or to ask MeridianComplete to cover the drug.

To get a temporary supply of a drug, you must meet the two rules below:

 

1. The drug you have been taking:

    • Is no longer on the MeridianComplete Drug List; or
    • Was never on the MeridianComplete Drug List; or
    • Is now limited in some way

2. You must meet one of these criteria:

    • You are new to MeridianComplete and do not live in a Long-Term Care Facility.
      In this case, we will cover a supply of your drug one time only during the first 90 days of your membership in MeridianComplete. This supply will be for up to a 31-day supply, or less if your prescription is written for fewer days. You must fill the prescription at a MeridianComplete network pharmacy.
    • You are new to MeridianComplete and live in a Long-Term Care Facility.
      In this case, we will cover a supply of your drug during the first 90 days of your membership in MeridianComplete, until we have given you a 98-day supply (consistent with the dispensing increment), or less if your prescription is written for fewer days.
    • You have been a MeridianComplete member for more than 90 days and live in a Long-Term Care Facility and need a supply right away.
      In this case, we will cover one 31-day supply, or less if your prescription is written for fewer days.

 

To ask for a temporary supply of a drug or to ask any questions you may have about a temporary supply of a drug, please call Member Services at

1-855-580-1689

(TTY 711), Monday - Sunday from 8 a.m. to 8 p.m.


When you receive a temporary supply of a drug, you should talk with your provider to decide what to do when your temporary supply runs out. You can either:

 

1. Change to another drug.

There may be a different drug covered by MeridianComplete that works for you. You can call Member Services at

1-855-580-1689

(TTY 711), Monday - Sunday from 8 a.m. to 8 p.m. to ask for a list of covered drugs that treat the same medical condition. The list can help your provider find a covered drug that might work for you.  

 

OR

 

2. Ask for an exception.

You and your provider can ask MeridianComplete to make an exception. For example, you can ask MeridianComplete to cover a drug even though it is not on the Drug List. Or you can ask MeridianComplete to cover the drug without limits. If your provider says you have a good medical reason for an exception, he or she can help you ask for one.

 

If you need help or you’d like to learn about asking for an exception, please call Member Services at

1-855-580-1689

(TTY 711), Monday - Sunday from 8 a.m. to 8 p.m. 

MEDICARE DISCLAIMER

MeridianComplete is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees.

 

You can get this document in Spanish, or speak with someone about this information in other languages for free. Call

1-855-580-1689 (TTY users should call 711)

,

Monday - Sunday, 8 a.m. to 8 p.m.

  The call is free.

 

Usted puede obtener gratuitamente este documento en español o hablar con alguien sobre esta información en otros idiomas. Llame al

1-855-580-1689

(los usuarios de TTY deben llamar al 711), lunes a domingo, de 8 a.m. a 8 p.m. La llamada es gratuita.

 

Limitations, copays, and restrictions may apply. For more information, call MeridianComplete Member Services or read the MeridianComplete Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year

The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.

 

Copays for prescription drugs may vary based on the level of Extra Help you receive. Please contact the plan for more details.

 

For certain kinds of drugs, you can use the plan’s network mail-order services. We also have an optional automatic mail-order delivery program under which we will automatically fill all new prescriptions your health care provider sends to us, as well as refills for prescriptions that have already been filled but are running out. Usually a mail-order pharmacy order will get to you in no more than 5 days. If you experience any problems receiving your mail order prescription, call Member Services at

1-855-580-1689 (TTY users should call 711)

.

Page Last Modified: 11/20/2017 2:43:27 PM