Medicare Programs

Medicare Programs

Last Updated: Thursday, July 06, 2023

  • cpa/ sepa
  • wpa/ nepa

TheĀ Medicare Programs is only applicable to Pennsylvania.

Medicare Part B Drug Website

Effective January 1, 2014, Highmark provides a link to the Medicare Part B Drug website. This link from the Centers for Medicare and Medicaid Services (CMS) website includes the annual Medicare Part B Drug Average Sale Price. Select the year appropriate for your inquiry. CMS will make quarterly updates in January, April, July, and October of the current year.

Medicare Part B Drug Average Sales Price

Notes:

  • The absence or presence of a HCPCS code in this table does not, necessarily, indicate coverage of the drug.
  • Certain drugs may require prior authorization and/or follow medical policy guidelines.

Medicare Part D Hospice Prior Authorization Information

Please use this form to submit requests to determine coverage eligibility for drugs under Medicare Part D when the member is enrolled in Hospice (as per Highmark Pharmacy Policy J-30).

Provider Manual


Additional information on Prescription Drug Programs can be found in the Highmark Provider Manual - Chapter 4, Unit 6.

Provider ManualĀ