Pharmacy Information

Changes to Rx Processing Under Channel Alignment Program
Highmark has implemented the Channel Alignment Program to ensure that drugs which are more appropriately billed through the pharmacy benefit are not billed under the medical benefit. This document has details about the program and which drugs are included in this program.
Medicare Part B Drug Average Sales Price
Medicare Part D Hospice Prior Authorization Information Form
Please use this form to submit requests to determine coverage eligibility for drugs under Medicare Part D when the member is enrolled in Hospice (as per Highmark Pharmacy Policy J-30).
Pharmaceutical Management (Clinical Management Programs)
This page provides an overview of Highmark's Pharmaceutical Management programs: Quantity Level Limit Program and Prior Authorization.
Program for Self-Administered Injectable or Oral Biotechnology Drugs
This page explains the Self-Administered Injectable or Oral Biotechnology Drug Program.
Site of Care Drug Management Program
This program is designed to improve the experience for members using certain medically billed infusion drugs that are considered safe and effective for administration outside of a hospital setting.

Last updated on 12/29/2023 12:37:14 PM

The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield. West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.

All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.

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