Policies & Programs

Policies & Programs

Learn about Highmark's comprehensive set of medical policies, care management programs, formulary, and pharmacy programs.

Medical Policies

Find the information you need to navigate coverage, including policy search, MCG clinical criteria, medical policy FAQ, and more.

Highmark Programs

Care Management


Our Care Management programs integrate the delivery of health care services with our members, their employers or groups, and our network providers.

Pharmacy Programs


Highmark's Pharmacy programs are designed to ensure that our members have access to the medications they need while managing costs.

Formulary


The Highmark Formulary is a list of prescription drugs reviewed by our Pharmacy and Therapeutics (P&T) Committee to promote quality, cost-effective patient care.

Telehealth

Highmark's Telehealth programs are designed to empower patients to be more engaged with their everyday health, and to help them manage their care between office visits. 

Additional Help

If you're unable to find the information you need or want to understand our policies and programs in more detail, please refer to our Provider Manual.