Oncology Drug Commeral Member Copay Reduction Program

By August 2026: Billing and clinical teams must implement the following: (1) Pharmacy/Billing team: Update billing system to recognize the 33 eligible oral oncology medications listed in the policy and apply reduced copay benefits when claims are submitted for qualifying cancer indications. (2) Clinical staff: Ensure CoverMyMeds forms are completed and submitted with prescriptions for eligible medications to document that the drug is being used for FDA-labeled or NCCN Category 1/2A cancer indications (e.g., methotrexate for acute lymphoblastic leukemia). (3) Front-desk/eligibility staff: Notify Florida Blue and Truli for Health members currently on eligible medications about the program and reduced copay benefits. (4) All staff: Do not apply copay reduction for non-oncology indications or medications on the Oral Oncology Parity Drug list. Failure to properly verify oncology indication and apply the reduction will result in incorrect member cost-sharing and potential claim adjustments. Reference the full program summary at MyPrime for implementation details.