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Medical Injectable Drug Program

On January 1, 2023, Highmark Blue Shield ended its exclusive arrangement with Alliance Rx Walgreens Pharmacy and will be utilizing Free Market Health to support the Medical Injectable Drug (MID) Program.

Physicians in the KHPW network, located in the 29-county western region of Pennsylvania­, must have a specialty pharmacy assigned by Free Market Health to obtain these drugs and cannot buy and bill for drugs that are considered MID mandatory

The program is optional for Employee Health Benefits Program (FEP) and BlueCard® claims.

If a drug has been designated as a mandatory MID drug, a specialty pharmacy must be assigned through Free Market Health. If a drug is designated as a voluntary MID drug, a physician can choose to buy and bill, or have a specialty pharmacy assigned through Free Market Health. Network physicians can also choose to buy and bill voluntary MID drugs, in which case reimbursement will be governed by previous bulletin communications.  

Highmark Blue Shield does not reimburse network physicians for products included in the Medical Injectable Drug Program.

  • More information around Free Market Health
  • List of drugs that are included in the program
  • Below is the necessary information that should be provided on the prior authorization to limit and reduce the additional outreaches to the Provider's office. 
    • Patient name, address, DOB
    • Date needed
    • Diagnosis code in ICD10 format
    • Patient weight
    • Prescription Insurance Information
    • Drug name and strength
    • Directions
    • Quantity
    • Refills
    • MD Signature, address, and contact information
    • Date written
    • Allergies, Medical conditions, and concurrent medications
    • Prior authorization numbers or information if already obtained
    • Any other additional information required
Last updated on 12/14/2022 11:24:21 AM

 

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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.