Effective 7/6: Superior HealthPlan Split-Fill Program

Date: 05/18/20

Effective July 6, 2020, Superior HealthPlan is implementing a Split-fill Program for select medications billed through the pharmacy benefit for Superior Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP members in order to minimize medication waste.

The severe side effects often associated with chemotherapy and other specialty drugs are a major driver for early medication discontinuation. Many patients who begin a new regimen on these drugs will stop taking their medication(s) within the first 90 days of therapy. The Split-fill Program allows members to receive up to a 15-day supply of medication filled for the first 90 days of therapy.

Members who are able to tolerate therapy after this introductory period will be permitted to fill a standard 30-day supply of medication moving forward. After the first 90 days of therapy, if a member is on a schedule to change their dose throughout treatment, the member will not be subject to the reduced quantity per fill when their dosage is re-evaluated.

Superior has identified and targeted 53 specialty medications that are associated with high discontinuation rates due to severe side effects. See table below for a list of medications in the Split-fill Program:

Abiraterone	Erlotinib	Lenvima	Stivarga	Vizimpro	Zytiga
Afinitor	Esbriet	Lynparza	Sutent	Votrient
Afinitor Disperz	Exjade	Nerlynx	Tagrisso	Xalkori
Alecensa	Gleevec	Nexavar	Talzenna	Xtandi
Alunbrig	Iclusig	Ocaliva	Tarceva	Yonsa
Bexarotene	Imatinib	Ofev	Targretin	Zejula
Bosulif	Inlyta	Palynziq	Tasigna	Zelboraf
Cabometyx	Iressa	Rebetol	Tavalisse	Zolinza
Calquence	Jadenu	Rubraca	Tykerb	Zydelig
Erivedge	Jakafi	Sprycel	Verzenio	Zykadia

Please reference the Texas Medicaid Preferred Drug List (PDL) for a complete list of covered medications: www.txvendordrug.com/formulary/prior-authorization/preferred-drugs

Providers can request prior authorization for a 30-day supply if the member has already been established on therapy or it is medically necessary.

For any questions or to request prior authorization, please contact Superior’s Pharmacy department at 1-800-218-7453, ext. 22080.