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2018 Prescription Drug Transition Process

If you are a new or current Tufts Health Unify member, we can help you transition your prescription drug if it is not on our List of Covered Drugs (Drug List). We may cover a temporary supply of your drug. Then your doctor can help you decide if there is a similar drug on the Drug List you can take instead, or if you should request an exception.

New Members

If you are living in the community

During the first 90 days of your enrollment, we will cover a temporary 30-day supply of your medication if the drug: 

  • Is not on our formulary
  • Requires prior authorization or
  • Is part of a step-therapy program

If you have a prescription written for fewer days, or if a quantity limit exists for safety purposes, you can receive multiple refills of the smaller quantity for up to a 30-day supply. You must fill your prescription at a network pharmacy.

If you are living in a long-term care facility

During the first 90 days of your enrollment, we will cover a temporary 91-day supply of your medication if the drug: 

  • Is not on our formulary,
  • Requires prior authorization or
  • Is part of a step-therapy program

If you have a prescription written for fewer days, or if a quantity limit exists for safety purposes, you can receive multiple refills of the smaller quantity for up to a 91-day supply.

Current Members

If you are living in the community

When we remove a drug from the Drug List, or we change our rules for getting a drug, we will cover a temporary 30-day supply during the first 90 days of the change. If you have a prescription written for fewer days, or if a quantity limit exists for safety purposes, you can receive multiple refills of the smaller quantity for up to a 30-day supply. You must fill your prescription at a network pharmacy.

If you are living in a long-term care facility

When we remove a drug from the Drug List, or we change our rules for getting a drug, we will cover a temporary 91-day supply within the first 90 days of the change. If you have a prescription written for fewer days, or if a quantity limit exists for safety purposes, you can receive multiple refills of the smaller quantity for up to a 91-day supply.

Additional Information

Once you receive your temporary supply, we will send you a letter that explains why your medication is only temporary. This letter also tells you how to work with your doctor and us to find an alternative drug from our Tufts Health Unify List of Covered Drugs. This letter will explain your right to request a coverage decision and describe the procedure for making that request. You or your doctor may request coverage for noncovered drugs, drugs requiring a prior authorization or drugs that are part of a step-therapy program.

For more information, please see the Tufts Health Unify List of Covered Drugs.



H7419_4520_CMS Approved
Page modified on: 12/29/2017 4:35:18 PM 

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