What happens if a drug a member takes is not covered?
A member may join the plan while taking a non-covered prescription drug. When this occurs, members taking the non-covered drug will have a 60-day “grace period” authorization to continue taking the prescription while they work with their provider to find an appropriate covered replacement (90 days for members in long term care facilities). If you think you need more time, or if you or your physician thinks that changing medications would not be in your best interests, you or your physician can file an exception request. For more information on filing an exception request, please see the appeals and grievance section. Click here for a link to the Exception Request form.
