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New Member Prescription Transition

In accordance with Medicare regulations, Inter Valley Health Plan has established a transition process for enrollees who are prescribed a non-formulary medication.

The process applies to:

  • New members who are stabilized on a non-formulary medication; and
  • Current members who are stabilized on or newly prescribed a non-formulary medication following discharged from a hospital or admission to/discharge from a long-term care (LTC) facility (i.e., unplanned transitions).

Through this process, members are eligible to receive a one-time, 30-day temporary supply of the non-formulary medication. The temporary supply may be extended up to 31 days for LTC members stabilized on multiple non-formulary medications.

This "first-fill" policy allows members the opportunity to discuss alternative drug therapy with their physician or initiate an exceptions request for continued coverage of their non-formulary medication.

The member, the member's appointment representative or the member's physician may request an exception coverage of non-formulary medications.



Updated 4/30/2020