Pharmacy Information

• Changes to Rx Processing Under Channel Alignment Program - Updated 11/19/2020
  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.
• Copay Armor Drug List - Updates Effective 7/1/2021
  The drug list in the Copay Armor program helps members to afford high cost medications (mostly specialty) by leveraging manufacturer coupon dollars.
• Diabetes Medications Dosing Guide This guide details dosing recommendations for Diabetes Treatment Agents.
• Express Scripts Mail Order FAQs
• Free Market Health - Effective 8/1/2021
  Free Market Health is a new innovative specialty pharmacy model that aligns resources, risk, and accountabilities for pharmacy referrals and reimbursement.
• 5 Tips for Faxing Pharmacy Prior Auth Requests
  Does your office fax pharmacy prior auth requests? Print off this "poster" and hang it by your fax machine as a handy reminder on how to avoid delays!
• Hemophilia and Bleeding Disorder Drug Program and Drug List
• Medical Injectable Drug Program 
  This page explains the Medical Injectable Drug 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).
• Medication Alternatives for the Elderly
• Pharmaceutical Management (Clinical Management Programs) 
  This page provides an overview of Highmark's Pharmaceutical Management programs: Drug Utilization Review, Quantity Level Limit Program, Prior Authorization, Managed Prescription Drug Coverage (MRxC) Program, and Formulary Management
• Pharmacy Authorization Submission Process & Frequently Asked Questions (FAQs) 
  The Pharmacy Authorization function in NaviNet^® can speed up and streamline your daily process for contacting Highmark for Prescription Drug Submissions.
• Pharmacy Benefits Program 
  This page gives a brief overview of Highmark's Pharmacy Benefits Program and information about Highmark's Formulary and the Home Delivery (Mail Service) Service.
• Program for Self-Administered Injectable or Oral Biotechnology Drugs 
  This page explains the Self-Administered Injectable or Oral Biotechnology Drug Program.
• Prescriber Taxonomy FAQ
  This page explains Medicare Prescriber Prescriptive Authority Requirements, how to make
  taxonomy changes, and potential impacts if the taxonomy is not valid for prescribing.
• Understanding Formulary Restrictions & Requesting Authorization