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. 
• Copay Armor Drug List 
  The drug list in the Copay Armor 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.
• Copay Armor Drug List With Oncology
  The drug list in the Copay Armor 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. This specific version of the Copay Armor program includes oral oncology drugs and is applicable to our self funded line of business.
• Free Market Health
  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).
• Pharmaceutical Management (Clinical Management Programs) 
  This page provides an overview of Highmark's Pharmaceutical Management programs: Drug Utilization Review, 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.