Beginning in July 2021, Highmark engaged with Free Market Health (FMH), an independent healthcare technology company, to launch an innovative, value-based specialty pharmacy program. Our engagement with Free Market Health enables a dynamic referral process in which all in-network specialty pharmacy providers have the opportunity to service members’ needs based on quality and cost. Please note: This may result in new specialty pharmacies servicing prescribers and their patients. The assigned pharmacy will reach out to obtain the prescription and is authorized to service the referral. Prescribers should provide the prescription to the assigned pharmacy when requested.
List of FMH Contracted In-Network Pharmacies
*List of pharmacies is subject to change
How the new specialty pharmacy model works:
- Upon an approved prior authorization for select specialty drugs, Free Market Health receives the patient referral for management. Note: if the authorization request is approved to be administered via a “Buy & Bill” scenario (drug procured and billed to Highmark by prescriber for outpatient/office administration), the member’s drug referral will NOT be assigned through the Free Market Health program.
- Free Market Health then orchestrates Highmark’s program configuration, including ensuring referrals are assigned to participating specialty pharmacies to maintain continuity of care, based on specific patient care needs and health plan program design.
- Referrals not subject to continuity of care are made available to in-network eligible specialty pharmacies to quickly and easily access and compete for the referrals best suited to their care model.
- Because any in-network specialty pharmacy will be able to access referrals for Highmark members, prescribers and members may notice new specialty pharmacies providing their medications.
- When a specialty pharmacy is assigned the referral, they will reach out to obtain the prescription. This pharmacy is assigned by Highmark to service the referral, and prescribers should provide the prescription as requested.
List of Eligible Drugs in the Program
*List of drugs is subject to change
REAL TIME AUTHORIZATION
For select prescribers, the Free Market Health program offers an improved prior-authorization submission process that shortens the time it takes for drug authorizations and referrals and improves speed to therapy for patients. Real Time Auth (RTA) is a web tool used to efficiently start the specialty drug referral process. Practices eligible to use Real Time Auth have been contacted by Free Market Health and have received onboarding information. If you believe you or your practice are eligible to use Real Time Auth and need support getting started, please email RTAfirstname.lastname@example.org
INFORMATION AND SUPPORT
Specialty pharmacies and prescribers of specialty drugs can reach the Free Market Health team at email@example.com for more information or help obtaining access to the Free Market Health applications. Support is available Monday - Friday, 9 a.m. - 6 p.m. EST.
Last updated on 9/15/2023 2:10:40 PM