Specialty medications are those used to treat serious or chronic conditions. Examples include hepatitis C, hemophilia, cancer and multiple sclerosis. They often require careful adherence to treatment plans, have special handling or storage needs, and may only be stocked by select pharmacies.
A split fill program may apply to some specialty medications like select oral oncology (cancer) drugs. This program lets the member try the medication first to make sure they can tolerate any potential side effects. With the partial fill, the member only pays for what was filled (a prorated cost).
More information is available in the specialty pharmacy program member flier.
The Specialty Pharmacy Program Drug List includes a reminder about coverage for self-administered specialty medications.
Coverage benefits and requirements may vary based on plan benefits.
Prime Therapeutics LLC is a pharmacy benefit management company, contracted by BCBSTX to provide pharmacy benefit management and related other services. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC.