Rx Processing Changes for Three Drugs Effective Jan. 1, 2026
Mon, Sep 29, 2025
At Highmark, we’re taking action to ensure our members are accurately billed for the treatment they receive and that providers are accurately reimbursed for the care they deliver.
Highmark 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.
As part of Channel Alignment Program, Highmark will shift certain drugs to process from members’ medical coverage to their prescription drug coverage, according to the terms of their Highmark plan. Effective Jan. 1, 2026, the following drugs (and procedure codes) will be included in this program.
Procedure Code |
Drug Name |
J3357 |
Stelara SC |
Q9997 |
Pyzchiva |
Q5137 |
Wezlana |
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