TotalCare (HMO D-SNP) Prescription Drug Transition Policy

If you are a current member or new to the TotalCare plan, you may be taking a drug that is not on our TotalCare List of Covered Drugs (formulary) or is on our list but has rules like prior authorization, step therapy and/or quantity limits. In these cases, you should talk to your provider about other medicines that are on our formulary. If there are no good options, you or your provider can ask for a formulary exception to cover the drug or remove the restrictions. While you and your provider decide what to do, we may cover up to a one-month supply of the drug during your first 90 days of coverage. This applies to drugs that are not on our formulary or on our formulary but have prior authorization, step therapy and/or quantity limits

If you live in a long-term care facility, we may cover up to a one-month supply of the drug during the first 90 days of coverage. After the first 90 days, we may also provide a 31-day emergency supply, unless your doctor prescribes fewer days.

If you move into or out of a hospital or long-term facility, we may also cover a one-month transition supply of your drug during that change.

If you have any questions about our transition policy or need help asking for a formulary exception, please contact MedImpact Customer Service: Phone: 800-347-5841 (TTY: 711), 24-hours a day, 7 days a week, beginning Jan. 1, 2026.