Channel Alignment Program
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:
