Under limited circumstances, TRDP enrollees shall be disenrolled by the contractor before the completion of an enrollment period commitment upon request by an enrollee if the enrollee submits written, factual documentation that independently verifies that one of the following extenuating circumstances occurred in the course of the enrollment interval. In general, the circumstances should be unforeseen and long-term and will have to have originated after the effective date of TRDP protection. All enrollee requests for termination of TRDP coverage before the completion of an enrollment period shall be submitted to the TRDP contractor for willpower of whether the enrollee qualifies to be disenrolled under paragraphs or of this section. Beneficiary transition provisions. A covered drug not beneath an settlement beneath paragraph of this part requires preauthorization underneath paragraph of this section to be offered through a retail network pharmacy underneath the Pharmacy Benefits Program. This preauthorization requirement doesn’t apply to different points of service beneath the Pharmacy Benefits Program.

Leave a Reply