Point32Health is implementing a pharmacy split fill program, effective March 1, 2025, for new starts on select oral oncology drugs for members of the following products: Tufts Health Direct, Harvard Pilgrim Health Care and Tufts Health Plan fully insured Commercial members, and those on the Commercial Exchange.
The oncology split fill program aims to improve medication adherence among our member population while managing drug costs and reducing drug wastage. Oral oncology drugs are vital for treating many types of cancer, but can cause severe side effects that may require the patient to change their dosage or stop the medication therapy altogether and select an alternative.
Because finding the right dose can take a few months and obtaining a full month’s supply before determining the right dose can be needlessly expensive if changes are ultimately needed, we’re allowing eligible members to prevent unnecessary costs by receiving partial fills for select oral oncology drugs (evaluated using evidence-based criteria).
These members will receive split fills for the first three months on a new oral oncology drug. If cost share (copay/coinsurance) is applicable, members will pay a pro-rated cost share per claim. Once the member can tolerate the medication, the regular cost share amount will apply for the fourth month’s fill and every fill thereafter.