Blue Cross to begin piloting Transition Rx Fill Program

Blue Cross Blue Shield of Michigan will launch a pilot Transition Rx Fill Program this month to help improve new member and provider satisfaction. This program applies only to members new to our individual and small group plans with the Custom Select Drug List.

The program will allow members to receive a one-time, temporary coverage override of up to a 30-day supply. The selected drugs listed below require a prior authorization. This one-time fill will allow the member time to get the prior authorization needed for coverage of the requested medication or switch to a comparable preferred alternative. The program is limited to the first 30 days of eligibility.

Under the Transition Rx Fill Program, no more than a 30-day supply of a prescription can be provided for one copayment. A temporary coverage override is available through participating retail and mail-order pharmacies. Transition fills don’t apply to everyone; only those members included in the pilot.

These medications are included in the program:

• Axert
• Frova
• Relpax
• Zolmitriptan (generic form of Zomig)
• Benicar
• Benicar HCT
• Edarbi

How the program works

• The participating pharmacy submits a claim for a Transition Rx Fill Program member for one of the transition fill drugs.
• The claim will process as a transition supply.
• Blue Cross notifies the member and the prescriber by letter that the medication requires a prior authorization and a one-time temporary coverage override has been authorized.
• The member is advised to work with their prescribing physician to request a prior authorization or switch to an alternative covered drug that does not require prior authorization.
• After the temporary coverage of a prior authorization is not approved for the drug, the claim will reject on a refill attempt.
  

If you receive questions from our members, please instruct them to contact Blue Cross Customer Service by calling the number on the back of their ID card. If you have any questions about our pharmacy programs, call the Pharmacy Services Clinical Help Desk at 1-800-437-3803 and select Option 1.