Our transition policy allows for a one-month coverage for members who have an immediate need for a drug not on our formulary, subject to restriction, or no longer covered. You should switch the member to a different drug or request a formulary exception. We may provide the member with a temporary transition supply while you pursue an exception. The drug must be a Part D drug purchased at a network pharmacy.
The following table summarizes the rules for receiving a transition supply of a drug. Members should read their plan’s evidence of coverage (EOC) for details.
Transition eligible situations:
To request a formulary exception, you may use the online tool at professionals.optumrx.com or call our Pharmacy Department at 1-800-711-4555.