Highmark blue shield rx prescription pain medication

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For all other Highmark members, complete the Prescription Drug Medication Request Form and mail it to the address on the form. Contact Us. Provider Directory. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania.

Quick Links: Manuals. Highmark Provider Manual. Medical Policy Medical Policy. Medical Policies. Medicare Advantage Medical Policies. If you are taking or prescribed a drug that is not on your plan's Drug List, call the number on your member ID card to see if the drug may be covered by your medical plan. Be sure to review your benefit materials for details. Type in the word or phrase you are looking for and click on Search. Starting January 1, , some changes will be made to the prescription drug benefit.

Review the changes. You, or your prescribing health care provider, can ask for a Drug List exception if your drug is not on the Drug List. To request this exception, you, or your prescriber, can call the number on the back of your ID card to ask for a review.

If you have a health condition that may jeopardize your life, health or keep you from regaining function, or your current drug therapy uses a non-covered drug, you, or your prescriber, may be able to ask for an expedited review process. BCBSOK will let you, and your prescriber, know the coverage decision within 24 hours after they receive your request for an expedited review.

If the coverage request is denied, BCBSOK will let you and your prescriber know why it was denied and offer you a covered alternative drug if applicable. Call the number listed on your member ID card if you have any questions. If your company has 51 or more employees, your BCBSOK prescription drug benefits may be based on one of the following drug lists. These drug lists are a continually updated list of covered drugs.

These can include Platinum, Gold, Silver, or Bronze plans. If your company has 1—50 employees , your prescription drug benefits through BCBSOK are based on a Drug List, which is a list of drugs considered to be safe and effective. This drug list coverage ended December 31, , with the exception of a plan with an off-cycle renewal date. Check your benefit materials for details.

Starting January 1, , some changes were made to the prescription drug benefit. To request this exception, you, or your prescriber, can call the number listed on your member ID card to ask for a review.

These health plans are not a "metallic" health plan and were effective before January 1, These drug lists are a list of drugs considered to be safe and effective.

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A prescription is required for these drugs and the member must obtain the medication through the pharmacy for coverage to apply. The member is charged the generic copayment. Premier Pharmacy Networks The prescription drug program offers a wide network of pharmacies and various pharmacy networks, including most national chains and many local, independent pharmacies. Members receive a directory of pharmacies with their enrollment materials. Pharmacies have point-of-sale technology that confirms a member's eligibility, benefit design and copayment information at the time of dispensing.

Managed care members must use one of the participating pharmacies in Highmark's Premier Pharmacy networks. Members may consult their pharmacy directory, visit Highmark's web site at www. This committee is comprised of network physicians and pharmacists who select products on the basis of their safety, efficacy, quality and cost to the plan.

The formulary is designed to assist in maintaining the quality of patient care and containing cost for the patient's drug benefit plan. Products are removed from the formulary twice a year, January 1st and July 1st, after a minimum of 30 days notification is given to providers. To obtain a copy of the formulary, contact your Provider Relations representative. Highmark's Medical and Pharmacy Affairs department monitors provider-specific formulary prescribing and communicates with providers to encourage use of formulary products.

The drug formulary is divided into sections based on the member's plan benefit design. For members with a Highmark Select or Highmark Choice formulary benefit, non-formulary drugs are not covered under a Select formulary benefit or will require a higher co-payment under a Choice formulary benefit. The drug formulary is then divided into major therapeutic categories for easy use.

Products that are approved for more than one therapeutic indication may be included in more than one category. Drugs are listed by brand and generic names. Most dosage forms and strengths of a drug are included in the formulary. Home delivery service is an option that groups may select depending on their benefit design.

Members may call the Member Services telephone number on their identification card to find out if they have home delivery coverage. Advantages of Using the Home Delivery Service Members may prefer to use the home delivery prescription service. This service enables members to obtain up to a day supply of either generic or brand name drugs, for either one or two times the retail generic or brand co-payment, or applicable coinsurance, depending upon the member's benefit plan.

How to Assist Members in Using the Home Delivery Service If a member must begin taking a new maintenance drug immediately, they may need to have two prescriptions. The member can have one of the prescriptions filled at a local pharmacy to begin taking the medication immediately. It is recommended that this prescription be written for a two-week supply. The member can send the other prescription to the home delivery service for up to a day supply.

How Members Use the Home Delivery Service Members can obtain home delivery forms for maintenance drugs by calling the Member Service telephone number on their ID card, or by calling MedcoHealth directly at: Once a member places an order, the member's information remains on file.

Provider Directory. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Quick Links: Manuals. Highmark Provider Manual. Medical Policy Medical Policy. Medical Policies.

Medicare Advantage Medical Policies. Requiring Authorization. Pharmacy Policy Search.