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Last Updated: Wednesday, May 01, 2024
Effective 10/01/2019, Highmark is taking action to ensure members are accurately billed for the care 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 this program, Highmark will shift certain drugs to process under members’ prescription drug coverage that were previously processed under their medical coverage according to the terms of their coverage.
The drugs included in this program can be found in the code list below:
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Additional information can be found in Chapter 4, Unit 6 - Prescription Drug Programs in the Highmark Provider Manual.
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®Blue Shield and the Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies.
The following entities serve central and southeastern Pennsylvania and are independent licensees of the Blue Cross Blue Shield Association: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company.
All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies