Prime Specialty Pharmacy: Split Fill for Oral Oncology Medications Now in Effect
Patients who are new to oral oncology medications (such as Tarceva, Sutent and Nexavar) often are unable to tolerate this form of treatment. To reduce waste and help avoid cost for medications that will go unused, as of 1/1/2010 the Triessent specialty pharmacy program will split the first fill of any initial Tarceva, Sutent and Nexavar prescriptions. Members will receive their first fill in two separate shipments. Members are contacted prior to shipment of their medication, and must agree to have their medication dispensed in partial fills.
For a member's first fill, a 16-day supply is sent, followed by a 14-day supply if the patient is able to tolerate the medication. If, after the first 30 days, the member is able to continue with treatment, fills will continue based on the prescriber's direction and the member's benefit design.
The member's share is prorated for each shipment. Prorating the copayment is managed through a one-time prior authorization. For members with a flat-dollar copayment, 53 percent is charged when the initial 16-day supply is shipped. The balance of the copayment for the 14-day supply is then charged when it is shipped, if the member is able to continue therapy. For benefit plans that include a coinsurance minimum/maximum, Prime Therapeutics will determine the member's share for the 30-day supply, considering the maximum, before the 16-day fill is shipped and the member will be charged 53 percent of that amount. The member will then be charged the remaining 47 percent for the 14-day supply at the time of shipment.
Should you have any questions, please contact your local Professional Provider Network office.