What can you do if a drug you are taking is not on the formulary or if the drug is restricted in some way? If your drug is not on the formulary or is restricted, here are things you can do:

• You may be able to get a temporary supply of the drug (only members in certain situations can get a temporary supply)
• You can change to another drug plan
• You can request an exception and ask Bridgeway to cover the drug

Under certain circumstances Bridgeway can offer a temporary supply of a drug to you when your drug is not on the formulary or when it is restricted in some way. Doing this gives you time to talk with your doctor about the change in coverage and figure out what to do.

To be eligible for a temporary supply, you must meet the two requirements below:

1. The drug you have been taking is no longer on Bridgeway’s formulary or — the drug you have been taking is now restricted in some way (Section 5 in the Evidence of Coverage has more information).
2. You must be in one of the situations described below:
   1. For those members who were enrolled with Bridgeway last year and aren’t in a long-term care facility: We will cover a temporary supply of your drug two times only during the first 90 days of the calendar year. These temporary supplies will be for a maximum of a 30-day supply, or less if your prescription is written for fewer days. The prescription must be filled at a network pharmacy.
   2. For those members who are new to Bridgeway and aren’t in a long-term care facility: We will cover a temporary supply of your drug two times only during the first 90 days of your membership in Bridgeway. These temporary supplies will be for a maximum of a 30-day supply, or less if your prescription is written for fewer days.
   3. For those who are new Bridgeway members, and are residents in a long-term care facility: We will cover a temporary supply of your drug during the first 90 days of your membership in Bridgeway. The first supply will be for a maximum of a 31-day supply, or less if your prescription is written for fewer days. If needed, we will cover additional refills during your first 90 days in Bridgeway.
   4. For those who have been a member of Bridgeway for more than 90 days, and are a resident of a long-term care facility and need a supply right away: We will cover one 31-day supply or less if your prescription is written for fewer days. This is in addition to the above long-term care transition supply.

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Last Updated: 2/02/2012