CurrentBlue Cross Blue Shield - OklahomaPolicy N/A

Split Fill Program Drug List

Defines medications included in BCBS Oklahoma's split fill program, which provides partial (prorated) initial fills for members new to therapy to reduce drug waste and plan costs; applies to members and providers under BCBSOK pharmacy benefits.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicySplit Fill Program Drug List

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionVerify member benefits and prior authorization requirements by calling the number on the member's ID card before dispensing.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3 monthsmaximum split fill duration

120 daysnew-to-therapy definition

Oral oncology +major drug categories

Split Fill Program — Coverage Criteria

Split Fill Program Eligibility

Covered when ALL of the following are met

Split fill eligibility: Member is new to therapy (no prescription filled in the past 120 days) AND medication is included on the Split Fill Program drug listup to 3 months partial/prorated fills

Each drug is evaluated using evidence-based criteria to determine frequency and duration of split fill requirements

The listing of a drug in this split fill program does not guarantee coverage or payment. Coverage is subject to the member's certificate or contract, including any benefits, limitations, and exclusions contained therein. Providers and members should verify coverage and benefit details by calling the number on the member's ID card and reviewing the member's certificate or contract. Regardless of benefit eligibility, the final decision about any medication is between the member and their health care provider.

Initial Split Fill Rules

Initial Split Fill

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicySplit Fill Program Drug List

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionVerify member benefits and prior authorization requirements by calling the number on the member's ID card before dispensing.

SourceLink

On This Page

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Provider Responsibilities & Verification

Prior Authorization

Prior Authorization / Benefit Confirmation

Verify prior authorization (PA) requirements and member benefit limits before dispensing. Contact the number on the member's ID card or use the payer's provider portal to confirm whether a PA is required and to obtain any PA forms or instructions.

This section does not list PA codes; check the payer's prior authorization lists for applicable codes and services.
Confirm any quantity limits, supply limits (including split-fill provisions), and duration limits that may affect coverage.

Step Therapy

Step Therapy Not Specified

Step therapy sequencing is not specified in this policy. The documented split-fill program identifies medications subject to prorated partial fills for new-to-therapy members, but does not establish a required step-therapy pathway.

If a step-therapy program applies for a member, verify requirements separately via the member's benefit plan or prior authorization resources.
Do not assume step-therapy substitutions or sequencing from the split-fill drug list alone.

Documentation Required

Coverage Verification

Providers must confirm member coverage and benefit limitations prior to prescribing or dispensing split-fill program medications.

Verify coverage using the member's ID card number and call the phone number on the card or access the payer portal.
If the member's benefits do not include the listed drug classes or program provisions, coverage may be denied; obtain PA or alternative authorization as needed.

Denial Risk

Verify Member Benefits

If a member does not have benefits that include the listed drug classes or the split-fill program, the medication may not be covered. Providers should verify benefits and document outreach when coverage is unclear.

Members new to therapy (no fill in past 120 days) may be eligible for prorated split fills for up to three months; confirm member-specific applicability.
For questions about a patient's benefits or for assistance, call the number on the patient's ID card.

Key Definitions

inv-08: New to therapy — definition

DefinitionA member without a prescription filled for the medication in the past 120 days.

ApplicabilityApplies to members considered new to therapy for medications on the split fill program drug list.

VerificationProviders should confirm member benefit coverage using the number on the member's ID card, as not all members' benefits include coverage for listed drug classes or programs.

inv-09: Split fill — definition

DefinitionA partial, prorated initial fill of medication provided to members at a prorated member cost share for up to three months of therapy.

PurposeDesigned to minimize drug waste and reduce health plan costs by targeting drugs with high rates of early discontinuation or dose changes.

DurationInitial split fills are provided for up to three months of therapy; each drug's frequency and duration are determined using evidence-based criteria.

OpenPayer

Split Fill Program Drug List

Split Fill Program — Coverage Criteria

Initial Split Fill Rules

Provider Responsibilities & Verification

Key Definitions

Program Rationale