New Copay Assistance Program for Certain Specialty Drugs Launching Jan. 1, 2027

Beginning Jan. 1, 2027, Highmark is offering a new medical benefit designed to lower out-of-pocket costs for eligible members who are receiving treatment with selected high-cost, provider-administered specialty drugs.

The Copay Armor Medical program, powered by HelpScript, connects eligible members with manufacturer-sponsored copay assistance. Once enrolled, the member’s copay responsibility is eliminated or significantly reduced when the drug claim is processed according to program guidelines.

Note: This is a medical drug benefit and operates separately from any pharmacy benefit copay programs.

How the Program Works

Your office will only need to take action if you are contacted directly by HelpScript.

The process is as follows:

1. Member Enrollment: HelpScript will proactively identify and contact eligible Highmark members to facilitate enrollment in a manufacturer’s copay assistance program.
2. Provider Education: If a member chooses to enroll, a HelpScript Patient Advocate will contact your office or facility to confirm the member’s enrollment and provide the necessary information for submitting the secondary claim.
3. Primary Claim Submission: Your office will submit the medical drug claim to Highmark for primary payment, following your usual process.
4. Secondary Claim Submission: After receiving the Provider Remittance Advice (RA) or Explanation of Payment (EOP) from Highmark, you will then submit the secondary claim to the manufacturer for direct payment of the member's copay amount.

If any balance remains after the manufacturer's copay assistance is applied, HelpScript will facilitate the final payment. There is no need to submit an additional bill to HelpScript. Payment is typically received within 14-21 business days after Highmark finalizes the primary claim.

Member Eligibility

• Eligible: Fully Insured Commercial (Pennsylvania Only) and Administrative Services Only (ASO) (Delaware, New York, Pennsylvania, and West Virginia).
• Not Eligible: Health Savings Account (HSA), Flexible Spending Account (FSA), High-Deductible Health Plan (HDHP), or government-funded insurance (e.g., Medicare, Medicaid, Tricare, CHIP).

Next Steps

A complete list of affected medications will be shared in upcoming communications. Be sure to join our mailing list to stay updated.