Does Part D transition 30 day supply of non formulary rx apply here ?

[policywunk]

I have a full dual prospect on medicare and silver scripts who wants to enroll in snp ma plan for 1/1/23 who is taking most expensive brand names Keppra and Topimax ( about 20k annual) which no part D or MA plan covers because there is cheap generics available however she currently has and has always been able to get a formulary exception because doctor will say the generic will make her sick or whatever.

I know she can ask for formulary exception after your coverage is in force and I know the 30 day transition exception would apply if there wasn't a generic available but would it apply if she insist on the brand name when there is a generic available?

 

[Fisher]

If I were in your shoes, I would start by calling the DSNP company and asking.

 

[DonP]

I have a full dual prospect on medicare and silver scripts who wants to enroll in snp ma plan for 1/1/23 who is taking most expensive brand names Keppra and Topimax ( about 20k annual) which no part D or MA plan covers because there is cheap generics available however she currently has and has always been able to get a formulary exception because doctor will say the generic will make her sick or whatever.

I know she can ask for formulary exception after your coverage is in force and I know the 30 day transition exception would apply if there wasn't a generic available but would it apply if she insist on the brand name when there is a generic available?

I’m pretty sure the carrier won’t give you an answer up front . They’ll say submit it .The issue you got if they deny you can’t move her back to the pdp till next aep .