How to Change to a Medicine on Our Formulary

If you are a new Passport Advantage member and have been taking a medicine that is not on our formulary, we will work with you and your provider to help you change to a medicine that is on our formulary.

If You Have Been a Passport Advantage Member for less than 90 Days

First, you may refill a prescription for a medicine you were taking before joining Passport Advantage. This refill will not be for more than a 30-day supply of your medicine.

You should call your provider to find out if you need an office visit so that he or she can decide what medicine to prescribe. While you are waiting for your visit, we will allow you to refill your prescription for the medicine two more times. Each of these refills cannot be for more than a 30-day supply. So, in total, we will have given you up to a 90-day supply of the medicine.

At your office visit, your provider will decide whether you can change to a medicine on our formulary or whether you and your provider should ask us for an exception to our rules so that you could continue to take the medicine that you were taking before you joined Passport Advantage. See Asking Us to Cover a Medicine for more information about asking for an exception.

If you are taking a medicine that requires tapering off, we will work with your provider to allow you to transition gradually from the medicine. However, for most medicines that require tapering off, we expect that you will have changed to a medicine on the Passport Advantage formulary or asked for an exception within six months of becoming a member.

If You Have Been a Passport Advantage Member for more than 90 Days

If you have been a member of Passport Advantage for more than 90 days and then try to refill a prescription for a medicine that is not on our formulary, we will work with you to help you change to a medicine that is on our formulary. But, we may ask you to change medicines faster than we explain above.

If You Live in a Long-Term Care Facility

If you are a new Passport Advantage member who is living in a long-term care facility at the time you join Passport Advantage, we have special rules about getting medicines.

We will let you refill prescriptions for medicines that you were already taking before you joined Passport Advantage for the first 90 days you are a member of Passport Advantage. If these medicines are not on our formulary or require authorization or step therapy, you or your provider must ask us about covering the medicine before the end of the 90 days. See Asking Us to Cover a Medicine for more information.