Expanding Care for Members with Substance Use Disorder

To provide greater support for members struggling with substance use, Highmark launched the Specialty Care – Substance Use Disorder (SUD) Expansion program, effective Jan. 1, 2026.

This program, a new component of Highmark's Mental Well-Being powered by Spring Health solution, offers a range of services, including:

• Specialty Care Navigators (SCN): SCNs provide proactive outreach, ongoing assessment, and long-term engagement for members at risk or expressing interest in behavior change.
• Comprehensive Support: The program offers medication-assisted treatment (MAT) for alcohol and opioid dependence, peer recovery coaching, and a Vetted Center of Excellence Network for in-network in-patient, detoxification, and residential programs.

All Specialty Care – SUD services are virtual, giving your patients convenient access that works with their schedules. This expansion will significantly enhance the support available to our members. We've prepared a brief overview video that is available on the Provider Resource Center (PRC) to help you quickly understand the key aspects of this program.

Member Access and Eligibility

Highmark members aged 18+ covered under a Highmark Commercial, Medicare Advantage (MA), Affordable Care Act (ACA), or Administrative Service Only (ASO) opt-in plan presenting with symptoms related to alcohol, cannabis, stimulant, opioid, or benzodiazepine dependence, and expressing interest in change, are eligible for Specialty Care – SUD.

Members already enrolled in the core Mental Well-Being solution for other behavioral health needs can move or be referred into Specialty Care – SUD based on self-reported assessments/routine screenings from Spring Health or on the advisement of their Spring Health clinical care team, care navigator, therapist, or prescriber. These services are available virtually, offering convenient access when needed.

You can refer your eligible patients into Mental Well-Being, including Specialty Care – SUD, through the Availity Essentials portal.