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.
SaveOn Drug List
The drug list in the SaveOn program helps members to afford high-cost medications (mostly specialty) by leveraging manufacturer coupon dollars. The drug list is updated biannually on 7/1 and 1/1.
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 5/19/2023 3:43:02 PM

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Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. 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.

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