Transition plan process
New members
Living in the community
During the first 90 days of your enrollment, if your medication is not on our formulary, requires prior authorization or is part of a step-therapy program, the network pharmacist will dispense a temporary supply of up to 30 days of your medication. If you have a prescription written for fewer days or if a quantity limit exists for safety purposes, you can receive multiple refills up to a 30-day supply. If the smallest available marketed package size exceeds a 30-day supply, Tufts Health One Care will provide a temporary supply when required.
Living in a long-term care facility
During the first 90 days of your enrollment, if your medication is not on our formulary, requires prior authorization or is part of a step-therapy program, the network pharmacist will dispense a temporary supply of up to 31 days of your medication. If you have a prescription written for fewer days or if a quantity limit exists for safety purposes, you can receive multiple refills up to a 31-day supply. If the smallest available marketed package sizes do not align with this time frame, Tufts Health One Care will provide a temporary supply when required.
Current members
Living in the community
If you are a current member affected by a formulary change from one year to the next, during the first 90 days of the new plan year, the network pharmacist will dispense a temporary supply of up to 30 days of your medication. If you have a prescription written for fewer days or if a quantity limit exists for safety purposes, you can receive multiple refills up to a 30-day supply. If the smallest available marketed package size exceeds a 30-day supply, Tufts Health One Care will provide a temporary supply when required.
Living in a long-term care facility
If you are a current member affected by a formulary change from one year to the next, during the first 90 days of the new plan year, the network pharmacist will dispense a temporary supply of up to 31 days of your medication. If you have a prescription written for fewer days or if a quantity limit exists for safety purposes, you can receive multiple refills up to a 31-day supply. If the smallest available marketed package sizes do not align with this time frame, Tufts Health One Care will provide a temporary supply when required.
After you receive your transition refill, we will send you:
- A letter detailing the temporary nature of the transition supply you have received
- Instructions for working with the plan and your physician to identify appropriate therapeutic alternatives that are on the Tufts Health One Care formulary
- An explanation of your right to request a coverage determination and a description of the procedures for requesting a coverage determination. You or your physician may request coverage for non-covered drugs, drugs requiring a prior authorization or drugs that are part of a step-therapy program.
If you have any questions about this process, please call member services toll-free at 1-855-393-3154 (TTY: 711), seven days a week, from 8 a.m. to 8 p.m.
Questions?
Call us toll-free at 1-855-393-3154 (TTY: 711)
Disclaimers
Tufts Health One Care is a health plan that contracts with both Medicare and MassHealth to provide benefits of both programs to enrollees. It is for people with both Medicare and MassHealth ages 21 through 64 at the time of enrollment.
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook (2024).
ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-855-393-3154 (TTY: 711), seven days a week, from 8 a.m. to 8 p.m. The call is free.
Si habla español, tiene disponible los servicios de asistencia de idioma gratis. Llame al 1-855-393-3154 (TTY: 711), siete días de la semana, de 8 a.m. a 8 p.m. La llamada es gratuita.
You can get this document for free in other formats, such as large print, formats that work with screen reader technology, braille, or audio. Call 1-855-393-3154 (TTY: 711), seven days a week, from 8 a.m. to 8 p.m. The call is free.
The List of Covered Drugs and/or pharmacy and provider networks may change from time to time throughout the year. We will send you a notice before we make a change that affects you.
Benefits may change on January 1 of each year.
H7419_2019_RXOPS9_C CMS Pending Approval