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 PremierBlueSM Shield network, located in central, eastern, or northeastern Pennsylvania, must have a specialty pharmacy assigned by Free Market Health to obtain these drugs for their Medicare Advantage (FreedomBlueSM) patients and cannot buy and bill for drugs that are considered MID mandatory
The program is optional for PPOBlueSM, DirectBlue®, EPOBlueSM, BlueCare® PPO,* Federal Employee Health Benefits Program (FEP), and BlueCard® patients.
* Alpha prefixes QEE, SNQ, and AUV only.
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
- 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 11:24:34 AM