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Claims and Billing

Medical Injectable Drug Program Changes in the New Year

WPA/NEPA
CPA/SEPA
DE
WV

Published Date: Thu, Sep 24, 2026

For: Professional Providers

Effective Jan. 1, 2027, Highmark is adding new drugs to our Medical Injectable Drug Program, while also adjusting reimbursement rates for those drugs. Reimbursement for the added drugs will now align with the average selling price (ASP); drugs lacking an ASP will use the average wholesale price (AWP). Drugs remain in the program once assigned a Healthcare Common Procedure Coding System (HCPCS) code.

The chart below features the drugs added to the program.

HCPCS No results were found for the keyword entered.	Drug Name No results were found for the keyword entered.

J0897	PROLIA
J0897	XGEVA
Q5136	JUBBONTI
Q5136	WYOST
Q5157	STOBOCLO
Q5157	OSENVELT
Q5158	CONEXXENCE
Q5158	BOMYNTRA
Q5159	OSPOMYV
Q5159	XBRYK
Q5161	BOSAYA
Q5161	AUKELSO
Q5162	BILDYOS
Q5162	BILPREVDA
Q5165	OZILTUS
Q5166	OSVYRTI
Q5166	JUBEREQ
Q5167	ENOBY
Q5167	XTRENBO
Q5171	BONCRESA
Q5173	PONLIMSI

Additional Information

Provider Resource Center (PRC): Medical Injectable Drug Program page

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Medical Injectable Drug Program Changes in the New Year

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