Highmark blue shield prescription coverage at walgreens

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Many of the criteria are automated in order to reduce the administrative burden on physicians and to reduce member disruption. Certain medications will require prior authorization to ensure the medical necessity and appropriateness of the prescription order as defined by Highmark prior authorization policies.

Generic medications can reduce prescription cost, and increase medication adherence while providing the same benefits as the brand name medication. This policy defines the criteria under which coverage for a brand name medication will be considered when generic products are available within the same therapeutic class. Medications targeted in program are used to treat acid reflux, cholesterol, and depression. If you or a covered family member need s to take a specialty medication, you will need to obtain the prescription from Walgreens Specialty Pharmacy, a mail-order pharmacy provider solely focused on specialty medications.

Additionally, this vendor offers a dedicated care coordinator to provide support to patients. For additional questions or concerns, contact Walgreens Specialty Pharmacy at Specialty medications are used to treat chronic, rare, or complex conditions such as rheumatoid arthritis, multiple sclerosis, or cancer. Additionally, specialty medications may: - Be given by infusion, injection, or taken orally.

Network physicians can also choose to buy and bill voluntary MID drugs, in which case reimbursement will be governed by previous bulletin communications. Highmark Blue Shield does not reimburse network physicians for products included in the Medical Injectable Drug Program.

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. Health Options Provider Manual. Medical Policy Medical Policy.

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