Medical Injectable Drug Program Changes in the New Year

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.

Preview the Changes

Ahead of Jan. 1, providers can preview the changes via the following document (log into Availity Essentials and follow the instructions below to gain access):

• MID Program Changes in the New Year

Once logged into Availity, select your region and go to Payer Spaces. Under Resources, select Communications Hub. You will be redirected to the Provider Resource Center’s Communications Hub, where you will select the Medical Injectable Drug Program Changes in the New Year article and the document link above will be unlocked and available to view.