Specialty Drug Split-Fill Program
Drugs Covered in Split-Fill Program
In an effort to provide greater patient support and avoid medication waste, Planintroduces our specialty drug split-fill program. The Specialty Drug Split-Fill Program allows members to try expensive medications that have serious side effects for a shorter time, confirming effectiveness and tolerance before Members pay for a full 30-day supply. This minimizes unnecessary expenses and reduces medication waste
The split-fill program applies to new starts only, Planmembers with commercial benefits, for the first two months of therapy. The program does not apply to members under our Medicare D, Medicaid Managed Care and Child Health Plus plans.
The following medications are included in the split-fill program:
- Piqray® 250mg and 300mg
- XuridenTM (limited distribution)
With this program, the monthly supply for included drugs will be split into two fills, each with a 15-day supply. The medication supply will be split for the first two months. The money the member pays for their medicine is less to match the smaller supply.
During the first two months of treatment, claims for included drugs will reject at point of sale if billed for greater than a 15-day supply. The pharmacy will need to rebill for a 15-day supply or less in order to get the claim to go through. After the member has received two months of treatment of a drug, it can be billed for full 30–day supply for subsequent fills.
If you have questions regarding this program, please contact the Pharmacy Help Desk at 1-800-724-5033.