Split Fill Program
Patients who are new to select specialty medications often are unable to tolerate this form of treatment. To reduce waste and help avoid costs of medication that will go unused, the Specialty Pharmacy program provides a partial, or “split”, fill of the member’s first monthly prescription for these select medications, when dispensed by Prime Therapeutics Specialty Pharmacy (Prime Specialty Pharmacy). Members have the opportunity to try these drugs to determine if they can tolerate the medication and any potential side effects before continuing therapy.
The service is currently offered for eight medications: Bosulif®, Lysodren®, Nexavar®, Sutent®, Tarceva®, Targretin®,Zolinza® and Zytiga®.
When a new prescription is received for one of these select medications, Prime Specialty Pharmacy will contact the member to confirm participation in the split fill program before the medication is sent. (Prime Specialty Pharmacy may also reach out to the member’s provider if they are unable to reach the member.) If a member does not wish to have a split fill of their medication, Prime Specialty Pharmacy will ship the full prescription amount and charge the member their full share, based on the member’s pharmacy benefit plan.
For members participating in the program, the first shipment is a 16-day supply. The member is contacted again prior to the second shipment of a 14-day supply being sent. Member share (copay/copayment) amounts are prorated to align with the number of pills dispensed. If the member pursues another fill thereafter, the member will receive the full supply and pay their full share. All member share costs are determined by the member’s pharmacy benefit plan.
Example: A member is prescribed a 30-day supply of Nexavar and it is the member’s first time taking this drug. The total cost of the drug is $1,500 and the total member copay based on their benefit plan is $500. The member share would be as follows:
- The member’s first fill for a 16-day supply (53% of 30) will process at $265 (53% of $500).
- If the member tolerates the drug, the second fill will be dispensed for a 14-day supply (47% of 30) and process at $235 (47% of $500).
- If the member pursues another fill thereafter, the member will receive a full 30-day supply and pay the full copay of $500.
Should you have any questions, please contact your local professional Network Management Representative.
Third-party brand names are the property of their respective owner. The list of medications included in this program may change from time-to- time.
Prime Therapeutics Specialty Pharmacy LLC (Prime Specialty Pharmacy) is a wholly owned subsidiary of Prime Therapeutics LLC, a pharmacy benefit management company. BCBSTX contracts with Prime Therapeutics to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSTX, as well as several other 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.