CALL SIM

This call scenario focuses on the common process for a Cigna Medicare Part D member to request an exception for an early refill or an extended supply due to international travel, a need that requires working with the pharmacy and the prescriber.

Call Scenario: International Travel Refill Request

Caller: Mrs. Eleanor Vance Member ID: [Member ID Number] Agent: Alex (Cigna Medicare Customer Service) Scenario: Mrs. Vance needs a 60-day supply of her maintenance medication for a two-month trip to the UK, but her refill is due too soon.

Opening and Verification

Alex (Agent): "Hi, thank you for calling Cigna Healthcare. My name is Ara. Whom do I have the pleasure of speaking with today?

Mrs. Vance (Member): Yes, my name is Eleanor Vance.

ALEX: "Thank you, Eleanor. To secure your account, could you please provide your Cigna Member ID and confirm your Date of Birth?

ELEANOR:

Alex (Agent): Thank you, Mrs. Vance. How can I help you today?

Mrs. Vance (Member): I'm calling because I'm going out of the country to visit my daughter in the UK for two months, and I need to get my medications refilled early. My regular high blood pressure medicine, Lisinopril, is only due to be refilled next week, and I'll need a full 60-day supply to cover my trip.

Alex (Agent): I understand completely. Traveling internationally and managing prescriptions can be tricky, but we can certainly see what options are available for an early travel override.

Alex (Agent): To confirm, you'll be traveling for approximately 60 days, and you need a 60-day supply of your Lisinopril for that period?

Mrs. Vance (Member): That's right. I leave in ten days, and I don't want to run out while I'm over there.

Alex (Agent): Thank you for planning ahead. Because your prescription drug coverage is through Medicare Part D, federal rules typically limit how early we can cover a refill. However, we do have an exception process for situations like extended travel, which requires a Vacation Override or Travel Exception.

The Action Plan

Alex (Agent): Here's the most efficient way to handle this, as it involves your pharmacy and your prescribing doctor:

Doctor's Approval is Key: For an early and/or extended supply, the best approach is for your prescribing doctor to send a new prescription to your pharmacy specifically for a 90-day supply (which would easily cover your 60-day trip). This often bypasses the need for an early refill override if they write the prescription as a long-term supply.

The Override Request: If your doctor can only write a 30-day prescription and you need two months' worth, your pharmacy will need to process the refill as an "early fill override" with the reason code for "vacation" or "travel." They will then submit that exception request to Cigna for approval.

Mrs. Vance (Member): So I can't just call the pharmacy and tell them I'm traveling?

Alex (Agent): You can and absolutely should call your pharmacy, but they'll need the information about your travel dates and the authorization from your plan. The smoothest way is for you or the pharmacist to contact your doctor first to see if they can authorize a 90-day supply. This is a standard benefit for many maintenance medications under Cigna, and it’s the easiest solution.

Next Steps and Controlled Substances

Alex (Agent): Do you take any other medications that you'll need for your trip, particularly any controlled substances? Medications like certain pain relievers, anxiety medicines, or ADHD drugs have much stricter federal rules and may not be eligible for an early or extended supply, even for travel.

Mrs. Vance (Member): I also take a thyroid medication, which is not a controlled substance.

Alex (Agent): Excellent. For your Lisinopril and your thyroid medication, I recommend you do the following immediately:

Call your Doctor: Ask them to send a new 90-day prescription to your preferred pharmacy (or Express Scripts Pharmacy if you use mail order).

Inform your Pharmacy: Let them know your travel dates (leaving in 10 days) and that your doctor is submitting the new, longer script, or that you need them to process a "travel override" for the extra supply.

Alex (Agent): If the pharmacy has any issues processing the override, please have them call our Pharmacy Help Desk line directly, as they can quickly communicate the travel exception requirements.

Closing

Alex (Agent): Mrs. Vance, to summarize: Please contact your doctor for a 90-day prescription and notify your pharmacy of your upcoming 60-day trip to the UK. Do you have any other questions about your Part D coverage while you're away?

Mrs. Vance (Member): No, that sounds like a clear plan. Thank you for your help, Alex.

Alex (Agent): You're very welcome, Mrs. Vance. Have a safe and wonderful trip! Thank you for choosing Cigna Medicare. [Call Ends]