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. (Please note: Our hours shift to Monday through Friday, from April 1 through September 30).