Specialty Pharmacy

Specialty Pharmacy Information

Specialty Split Fill Program

As you know, certain oral oncology drug therapies can result in treatment limiting side effects, adverse reactions, poor tolerability, or frequent dosing changes, with the potential to cause patient non-compliance or medication discontinuation. Subsequent waste can be costly, and remaining medication supplies are then unused and must be discarded. Beginning 4/1/22, Highmark Wholecare Pennsylvania Medicaid will implement a Split Fill Program for these drugs. For members new to therapy, the Split Fill Program will require partial medication fills (i.e., consecutive 15-day supplies) for the first three months of oral oncology drug therapy, ensuring sustained member tolerability of the drugs prior to filling a full supply. For any medication requiring a member copayment, the copayment amount will be evenly split between the first 15-day fill and the remaining 15-day supply each month. Please note, oral oncology drugs are currently excluded from any Pennsylvania Medicaid member copayment requirements.

Specialty Split Fill Program Drug List

Specialty Pharmacy Information

Some medications, including those that require special handling and some injectable medications, listed in the formulary are only available through a specialty pharmacy network. These medications are denoted as Specialty Pharmacy Group A or Specialty Pharmacy Group B in the formulary. To find a participating specialty pharmacy or view the list of medications that must be obtained through a specialty pharmacy, use the links below. If you have questions regarding the status of a particular medication or pharmacy, please contact: Highmark Wholecare Member Services at 1-800-392-1147.

Specialty Drug List

Specialty Pharmacy Provider List