New Member Transitions

SilverScript Medicare Transition Process

If you were taking a non-formulary drug, or a drug with a Step Therapy or Prior Authorization before joining our plan, SilverScript Medicare transition process allows the pharmacist who refills your prescription to provide you with a temporary 30-day supply* of the drug within the first 90-days of your membership in a SilverScript plan. Your cost is your plan's appropriate Tier copay and the prescription must be filled at a network pharmacy.


A transition supply allows you time to talk to your doctor about pursuing other options available to you within our formulary. Your plan cannot continue to pay for these medications under the transition policy, even if you have been a member for less than 90-days following your 30-day transition supply.

*A thirty (30) day supply is the maximum transition amount, and could be less if your prescription is written for fewer days.

If you receive a transition supply, you will receive a letter from your plan notifying you that you have received a temporary supply of your prescription drug. View a Transition Fill Letter. Please refer to your Evidence of Coverage for more detailed information on the SilverScript Medicare Transition Process.

New Members can request a Formulary Exception

As a new SilverScript member, you may be taking drugs that are not included on our formulary or are included but your ability to get them is limited. If this applies to you we encourage you to talk with your doctor about switching to appropriate alternative drugs that are included in our formulary. If there are no appropriate alternative drugs covered by our formulary, you or your doctor can request a Formulary Exception.


If your request for a Formulary 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 a temporary or transition supply of the drug anytime during the first 90-days of your membership in our plan.

New members who already take a non-formulary, Step Therapy or Prior Authorization prescription

If you were taking a non-formulary drug or a Step Therapy or Prior Authorization prescription drug before you joined SilverScript, the pharmacist who refills your prescription will be able to provide you with a temporary 30-day supply of your prescription drug during the first 90-days of your membership in our plan. Your cost would be your plan’s Tier cost-sharing amount (copay or coinsurance) and the prescription must be filled at a network pharmacy. A temporary fill allows you time to talk to your doctor about pursuing other formulary alternatives that are covered by your plan.

Transitioning New members who switch to a SilverScript plan and reside in a Long Term Care facility

If you were taking a non-formulary drug or a prescription drug with a Step Therapy or a Prior Authorization restriction before you joined SilverScript and if you also reside in a Long Term Care facility, the pharmacist who refills your prescription will be able to provide you up to a 102 day supply** of your prescription drug during the first 90-days of your membership in our plan. Your cost would be your plan's Tier cost-sharing amount (copay or coinsurance) and the prescription must be filled at a network pharmacy. This allows you time to talk to your doctor about pursuing other options available to you within our formulary.


**One hundred and two (102) days supply if consistent with the dispensing increment, unless you have a prescription written for fewer days.

Members who are affected by a formulary change

As a renewing or continuing member, you will receive your Annual Notice of Change (ANOC) by September 30. If, after reviewing your ANOC, you notice that a covered prescription drug you currently take will either not be covered on the 2017 formulary or its cost-sharing or coverage has changed for the 2017 plan year, you should discuss your situation with your doctor to either:

  • Find an appropriate alternative prescription drug that is covered by the 2017 formulary
  • Request a Formulary Exception before the 2017 plan year begins.

If your request for a Formulary Exception is approved, we will authorize coverage before January 1 of the 2017 plan year. After January 1, 2017–when your SilverScript coverage begins–you may be eligible to receive a temporary supply of your prescription drug while you work with your doctor to either obtain a covered alternative prescription drug or request a Formulary Exception.


When a drug you take is not covered by your plan

Medicare prescription drug plan formularies are not the same nor do they cover the same drugs. For that reason, there may be instances when a prescription drug you take is not covered by our formulary. It doesn't mean you need to leave our plan, because you may be able to get coverage for the drug through our Exception process. We can work with your doctor to find a covered alternative drug that your doctor believes is right for your condition.

When you discuss your prescriptions with your doctor, we encourage you to take along your plan's Comprehensive Formulary. If your doctor believes there are no alternative prescription drugs on our formulary that are right for treating your condition, you or your doctor may request a Formulary Exception. If we approve your request for a Formulary Exception, we will begin covering your drug on January 1 of the upcoming plan year.

If you need further assistance with any formulary-related issue or simply have questions about drug coverage in general, please contact Customer Care toll-free at 1-866-235-5660, 24 hours a day, 7 days a week. TTY users call 711.


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