US · guidance
CMS Pub. 100-18, ch. 6, § 30.4.2
General Transition Process
Part D sponsors must ensure that they have provided their enrollees who have used a transition
benefit with the appropriate assistance and information necessary to enable them to better
understand the purpose of the transition. Steps that sponsors should consider to ensure a
meaningful transition include:
• Analyzing claims data to determine which enrollees require information about their
transition supply.
• Contacting those enrollees to ensure they have the necessary information to enable them
to switch to a formulary product or as an alternative to pursue necessary prior
authorizations or formulary exceptions.
• Increasing call center capacity, including pharmacy help lines, to respond to an
anticipated increase in call volume from affected enrollees regarding the sponsor’s
transition process.
• Making arrangements to continue to provide necessary drugs to an enrollee by extending
the transition period, on a case-by-case basis, if the enrollee’s exception request or appeal
has not been processed by the end of the minimum transition period.
History
(Rev. 2, Issued: 07-18-08; Effective/Implementation Date: 07-18-08)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-09-17
- Edition
- iom-2026-09-17
- Content hash
5d1b1d0463bc3f5b45a6faa78c7d77cf57fdabd1fc67441426fb655534334222
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.