CurrentBlue Cross Blue Shield - OklahomaPolicy N/A

Split Fill Program Drug List

Lists drugs included in the payer's split-fill program that provides partial initial fills for members new to therapy to reduce waste; affects prescribers, pharmacists, and members subject to Blue Cross Blue Shield - Oklahoma 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 using the number on the member's ID card before dispensing and confirm eligibility for a partial split fill for members new to therapy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1program sections

3oral oncology chunks

1other drug chunks

Coverage Criteria

Split Fill 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 on the split fill program drug listup to three months of partial fill

Partial fills are prorated for member cost share

The listing of drugs in this policy is intended to identify products included in the payer's split-fill program but is not a guarantee of benefits. Member coverage, limitations, and exclusions may vary by contract; providers should verify the member's pharmacy benefits and cost-share using the telephone number on the member's ID card or by reviewing the member's certificate or contract of coverage prior to dispensing.

Coding / Operational Parameters

New-to-therapy lookback — no prescription filled in the past 120 days

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 using the number on the member's ID card before dispensing and confirm eligibility for a partial split fill for members new to therapy.

SourceLink

On This Page

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Lookback periodNo prescription filled in the past 120 days

Applies toMembers new to therapy for medications on the split‑fill program drug list

PurposeIdentify members eligible for a partial (split) initial fill

Maximum split-fill duration — up to three months of therapy

Maximum split-fill durationPartial fills may be provided for up to three months of therapy

ProrationPartial fills are prorated for member cost share

EvaluationEach drug's frequency and duration of split fill is determined by evidence‑based evaluation

Provider Actions & Verification

Note

Program targeting and evaluation

Members new to therapy (no prescription filled in the past 120 days) for certain medications may be eligible for a partial (split) fill of their medication at a prorated member cost share for up to three months. Each drug included in the split fill program is evaluated using evidence-based criteria and targeted because of high early discontinuation or dose-change rates; the frequency and duration of split fill requirements are set based on that evaluation.

Program targets drugs with known high early discontinuation or dose-change rates and evaluates each drug for frequency and duration of split-fill requirements.
Split-fill provision: partial fills provided for up to three months for new-to-therapy members (those without a fill in prior 120 days).

Prior Authorization

Coverage verification

Not all members' benefits include coverage for the drug classes or programs described. Providers should verify member benefits, copay/deductible applicability, and program applicability before dispensing. For coverage verification or assistance, call the number on the member's ID card.

If member benefits do not include coverage for the listed drug classes or programs, coverage may be denied.
Verify member-specific copays, deductibles, and whether the split-fill program applies to the member's benefit plan.

Background

The split-fill program is designed to minimize drug waste and reduce plan costs by dispensing partial initial fills for members new to therapy, with partial fills prorated for member cost share. The program targets medications with high rates of early discontinuation or dose changes and may apply a partial fill provision for up to three months of therapy for members who meet the program criteria; providers should verify individual drug requirements and member eligibility before dispensing.

Definitions

new to therapy — Members new to therapy: those without a prescription filled in the past 120 days.

DefinitionMembers new to therapy: those without a prescription filled in the past 120 days

ScopeApplies to medications included on the split fill program drug list

IntentAllows a partial initial (split) fill to reduce waste and account for early discontinuation or dose changes

Initial Therapy (Split Fill) Criteria

Initial Therapy (Split Fill)

Initial split fill rules

Initial split fill: Member is new to therapy (no prescription filled in past 120 days); dispense a partial (split) fill of the prescribed medicationup to three months

Partial fills are prorated for member cost share. Each drug's frequency and duration of split fill requirements are determined by evidence-based evaluation.