Medicare Programs
Last Updated: Thursday, July 06, 2023
- wpa/ nepa
- cpa/ sepa
The information on this page 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.
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.
