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
  Copay Armor, powered by PillarRx Consulting, helps to leverage manufacturer assistance dollars to lower prescription out-of-pocket costs. Copay Armor is driven off a unique set of drug lists of high-cost, mostly specialty, medications that utilize manufacturer copay assistance dollars.
  • For more information about the Copay Armor program, contact the Highmark Provider Service Center for your service area.
• Free Market Health
  Free Market Health is a new innovative specialty pharmacy model that aligns resources, risk, and accountabilities for pharmacy referrals and reimbursement.
• 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.