Highmark's Specialty Drug Management Expands to PA, DE & NY

Highmark announced the launch of our specialty pharmacy arrangement powered by Free Market Health in our PA/DE/NY ACA Individual Markets, effective July 1. 

What do I need to know?

Highmark's specialty pharmacy arrangement powered by Free Market Health is designed to offer members an enhanced clinical approach to managing their specialty medications while containing the cost of the drugs.

How does this work?

Highmark curated a network of high-quality specialty pharmacies with the help of Free Market Health. Pharmacies were hand-selected based on their ability to manage specific conditions at competitive prices. These pharmacies can bid on the specialty prescription referrals for Highmark's membership.

When Highmark approves a prior authorization for a specialty medication, it is routed to Free Market Health. Based on the member's condition, the pharmacies can bid on filling the prescription and managing the medication for the lifetime of the prior authorization (typically one year). Since these specialty pharmacies were already vetted and determined to be high-quality for these conditions, whichever pharmacy offers the lowest price for the medication wins the bid, and the patient is matched with them. From there, the pharmacy fills the medication and supports that member in their care journey.

What can my client and/or members expect?

There should be no work on the client or member since pricing negotiations and matching a member to the best specialty pharmacy happens behind the scenes after Highmark approves a prior authorization for a specialty medication. They can expect cost savings and an improved patient experience as we transition to a value-based approach to specialty pharmacy management. With Free Market Health, each member using a specialty drug will be matched with the best pharmacy for their specific needs, meeting the member where they are in their care journey and considering the complexity of their condition.

Members can expect a superior level of service under this new arrangement including:

• 24/7 access to patient care advocates, specialty-trained pharmacists, and/or nurses with specialty condition experience.
• Ability to manage specialty medications on the specialty pharmacy's website or mobile app.
• Refill reminders based on communication preferences: call, text, or email.
• Free medication delivery on a day that works for the member. In some cases, the specialty pharmacy will deliver to a local retail location.
• Most supplies, such as needles and syringes, are provided with specialty medication at no charge.
• Access to comprehensive, condition-specific patient care management programs. This clinical support is provided at no additional cost and member participation is completely voluntary.