Patients who are new to therapy for select specialty medications often are unable to tolerate these drugs. The member ends up discontinuing therapy early or modifying their dosage. To reduce waste and help avoid costs of medication that may go unused, Blue Cross and Blue Shield of Texas offers its members and groups a Split Fill Program. Members new to therapy (or have not had claims history within the past 120 days for the drug) are provided partial, or “split”, prescription fills for up to three months. This gives the member an opportunity to try these drugs, at a prorated cost share, to make sure they can tolerate the drug and any potential side effects before continuing ongoing therapy.
The Split Fill Program applies to a specific list of drugs. Each drug is evaluated using evidence-based criteria to determine the frequency and duration of a split fill. The list is subject to change at any time.
Members must use an in-network specialty pharmacy. This includes specialty pharmacies participating in our oral oncology network and Limited Distribution (LD) pharmacies.
The member receives their split fill and pays the applicable prorated member cost share (copay/coinsurance) amount for what is dispensed. Once the member is able to tolerate the medication, the applicable member cost share amount will apply for each fill received after completion of the program. Please Note: All member share costs are determined by the member’s pharmacy benefit plan.
If you have any questions, please call the number on your patient’s ID card.
The relationship between Blue Cross and Blue Shield of Texas and the specialty pharmacies is that of independent contractors.
Blue Cross and Blue Shield of Texas (BCBSTX) contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. In addition, contracting pharmacies are contracted through Prime Therapeutics. The relationship between BCBSTX and contracting pharmacies is that of independent contractors. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.
The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are instructed to exercise their own medical judgment. Pharmacy benefits and limits are subject to the terms set forth in the member's certificate of coverage which may vary from the limits set forth above. The listing of any particular drug or classification of drugs is not a guarantee of benefits. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.