Transition Notice
What if my current prescription drugs are not on the formulary or are limited on the formulary?
New Members
As a new member in our plan, you may currently be taking drugs that are not on our formulary or are on our formulary but your ability to get them is limited. Florida Health Care Plans has a Transition Program, in which FHCP works with your physician to find appropriate alternative therapies available on our formulary. At time of enrollment all new members received a Medicare Medication Transition form in their New Member Packet. We encourage all new members to complete the Medicare Medication Transition Form in its entirety and return to FHCP or simply drop it off at one of our FHCP Pharmacies. Once you send in your form and your enrollment takes effect, please check with the Florida Health Care Pharmacy you indicated on the front of the form to see if alternates to Non-Formulary medications were sent to the pharmacy by your physician.
If there are no appropriate alternative therapies on our formulary, you or your doctor can request a formulary exception. If the exception is approved, you will be able to obtain the drug you are taking for a specified period of time. While you are talking with your doctor to determine your course of action, you may be eligible to receive an initial 30 transition supply of the drug anytime during the first 90 days you are a member of our plan.
For each of your drugs that are not on our formulary or for situations where 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 transition supply, we may not continue to pay for these drugs under the transition policy. After you have used your initial transition supply, we may not continue to pay for those drugs under the transition policy. You are reminded to fill out our Medicare Medication Transition Form OR discuss with your physician appropriate alternative therapies on our formulary and if there are none, you or your doctor can request a formulary exception.
If you are a resident of a long-term care facility, we have an open formulary so transition supplies are not necessary.
Current Members
As a continuing member in the plan, you will receive your Annual Notice Of Change (ANOC) by October 31st of each year. You may notice that a formulary medication which you are currently taking is either not on the upcoming year's formulary or its cost sharing or coverage is limited in the upcoming year.
In this case, you must work with your physician to either find an appropriate alternative therapy on our new formulary, fill out a Transition Form to let us help you find a formulary alternate or request a formulary exception prior to the beginning of the new year. If the exception request is approved, we will authorize payment prior to January 1st and provide coverage beginning January 1st.
For patients discharged from an inpatient hospital stay on Non-Formulary medications, a 7 day supply will be filled at a formulary rate.
If you have any questions about our transition policy or need help asking for a formulary exception, call FHCP's Member Services Department at 386-615-4022 or 1-877-615-4022. From November 15 through March 1 of each year the hours of operation are 7 days a week, 8 a.m. to 8 p.m. From March 2 through November 14 of each year the hours of operation are Monday through Friday, 8 a.m. to 8 p.m. The hearing impaired may call TTY/TDD 877-260-8312.
