Bright Health wants to make getting Medicare Part D coverage for the treatment you need as seamless as possible. The policy applies to new members taking a medication that is not covered, members entering/discharging from a long-term care facility, or current members who are impacted by a formulary change. Designed to give members an opportunity to work with their doctors to complete a successful transition and avoid disruption in treatment, the policy ensures coverage for a temporary supply of medication.
The Transition Policy provides at least a one-time, temporary month's supply of medication, anytime during the first 90 days of your enrollment in the plan, beginning on your effective date of coverage.
We encourage members to talk with their doctors to decide if they should switch to a different drug that is covered or to request a formulary exception to get coverage for the drug.
After the transition period has expired or the days supply is exhausted, the transition policy will provide members living in a long-term care facility at least a 31-day emergency supply of non-formulary Part D drugs (unless the beneficiary presents with a prescription written for less than the 31 days) while an exception or prior authorization determination is pending.
For members being admitted to, or discharged from, a long-term care facility, the early refill edits will not be used to limit appropriate and necessary access to their Part D benefit, and such enrollees will be allowed to access a refill upon admission or discharge.
We will provide you with written notice within three business days of your temporary transition supply that will include instructions for requesting a formulary exception and how to work with your doctor to decide if you should switch to an appropriate drug we cover.
The transition policy applies to Part D drugs that (a) are not on the plan’s formulary; (b) were previously approved for coverage under an exception once the exception expires, and (c) that are on the plan’s formulary but require prior authorization or step therapy, or that have approved quantity limits lower than the beneficiary’s current dose, under the plan’s utilization management rules.
All prescriptions must be filled at an in-network pharmacy.
Last Updated: Fri Nov 23 2018
Bright Health plans are HMOs and PPOs with a Medicare contract. Bright Health’s New York D-SNP plan is an HMO with a Medicare contract and a Coordination of Benefits Agreement with New York State Department of Health. Our plans are issued through Bright Health Insurance Company or one of its affiliates. Bright Health Insurance Company is a Colorado Life and Health company that issues indemnity products, including EPOs offered through Medicare Advantage. An EPO is an exclusive provider organization plan that may be written on an HMO license in some states and on a Life and Health license in some states, including Colorado. Enrollment in our plans depends on contract renewal.
This information is not a complete description of benefits. Call 844-667-5502 | TTY:711 for more information.
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
You must continue to pay your Medicare Part B premium.
Every year, Medicare evaluates plans based on a 5-star rating system.
Medicare beneficiaries may also enroll in Bright Health Medicare Advantage plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov
Bright Health Medicare Advantage plans are plans with a network of doctors, hospitals, pharmacies, and other providers. Out-of-network/noncontracted providers are under no obligation to treat Bright Health members, except in emergency situations.
Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. You must generally use network pharmacies to fill your prescriptions for covered Part D drugs.
Other providers are available in our network. Most network providers participate through our Care Partner.
Bright Advantage Special Care (HMO SNP) has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) through 2021 based on a review of Bright Advantage Special Care (HMO SNP) Model of Care.
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