Prescription drug transition policy

Temporary medication supplies

As a new or continuing member in our Medicare health 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. You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan.

For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover a temporary 30-day supply (unless you have a prescription written for fewer 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.

If you are a resident of a long-term care facility, we will allow you to refill your prescription until we have provided you with at least 91 and up to 98-day transition supply, consistent with dispensing increment (unless you have a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is 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 will cover a 31-day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary exception.

Kaiser Permanente assures that members in transition have access to all Medicare Part D-covered medications without an interruption in therapy.

If you have questions about the prescription drug transition policy, please contact Member Services.

Prescription drug transition policy (PDF)

Questions? Call us

Prospective members
8 a.m. to 8 p.m., 7 days a week
1-800-446-8882
TTY WA Relay 711

Current members
MEMBER SERVICES
8 a.m. to 8 p.m., 7 days a week
1-888-901-4600
TTY WA Relay 711

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