Information on this Provider Resource Center site is for members who have moved onto Highmark's systems.
For information related to members who have not moved onto Highmark's systems, please visit bcbswny.com/provider.

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.
  • Pharmaceutical Management (Clinical Management Programs) 
    This page provides an overview of Highmark's Pharmaceutical Management programs: Quantity Level Limit Program and Prior Authorization.
  • 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 3/11/2022 3:16:36 PM

 

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