PHARMACY TRANSITION OF CARE
If you recently joined Mercy Care Advantage and you learn that we do not cover a drug you were taking before
you joined our Plan, you may be able to get a onetime 30 day fill of that prescription. You and your doctor will then get a letter from our pharmacy benefits manager, Express Scripts, notifying you that you will need to get a prescription for a formulary drug.
If you have been a member for more than 60 days and are requesting a refill of a drug that is not on our
formulary, we will require information from your doctor showing that you have used the drug for 6-8 weeks
prior to requesting the refill. If the request is supported, you may be able to get a one-time 30 day fill of
that prescription. You and your doctor will then get a letter from our pharmacy benefits manager, Express Scripts,
notifying you that you will need to get a prescription for a formulary drug.
If you are a new member and in a long term care facility, or are transitioning from the hospital to a long term care facility, you may be able to get a one-time 90 day fill of a non formulary drug. You and your doctor will then get a letter from our pharmacy benefits manager, Express Scripts, notifying you that you will need to get a prescription for a formulary drug.