Highmark blue rx

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Call the number on their member ID card from 8 a. Request a call from a Highmark Medicare Advisor. Connect with Highmark on Twitter or Facebook. Highmark Medicare Advantage plans are available in four states — Delaware, New York, Pennsylvania and West Virginia — and about , people are enrolled in Highmark plans as of October Highmark is tied with a few other health insurance companies for seventh place in terms of market share, and it saw the most Medicare Advantage growth in among the Blues plans, adding 78, new members for the plan year [0] The Chartis Group.

View all sources. Costs for Medicare Advantage plans will depend on your plan, geographic location and health needs. Of all the Blues, Highmark has the highest-priced Medicare Advantage plan in Other out-of-pocket costs to consider include:. Whether the plan covers any part of your monthly Medicare Part B premium. Whether your medical providers are in-network or out-of-network or how often you may go out of network for care. Whether you require extra benefits and whether the plan charges for them.

You can select by insurance carrier to see only UnitedHealthcare plans or compare across carriers. Average star rating, weighted by enrollment: 4. All Medicare Advantage plans are evaluated on health plan measures, and Medicare Advantage plans that include prescription drug coverage are also evaluated on drug plan measures. Based on the most recent year of data and weighted by enrollment, Highmark Medicare Advantage plans get an average rating of 4.

For comparison, the average star rating for plans from all providers in is 4. Of the Highmark Medicare Advantage contracts with star ratings in , two-thirds are rated 5 out of 5 and the other third are rated 4.

There are no contracts rated lower than 4 stars. To get an overall star rating, the CMS ranks contracts on 40 different plan factors. Here are the measures for which Highmark contracts scored an average of 4. Diabetes care — blood sugar controlled.

Getting appointments and care quickly. Health plan: Members choosing to leave the plan. Plan makes timely decisions about appeals.

Health plan: Call center — foreign language interpreter and TTY availability. Drug plan: Call center — foreign language interpreter and TTY availability. Drug plan: Members choosing to leave the plan. Medicare plan finder price accuracy. Medication adherence for hypertension RAS antagonists.

Highmark contracts struggled in a few of the categories measured. AM Best is a credit rating agency that specializes in the insurance industry. An A rating in this category indicates that AM Best believes Anthem has an excellent ability to meet its ongoing insurance obligations.

In its U. Medicare Advantage Study — the eighth it's done so far — J. Power measured member satisfaction with Medicare Advantage plans based on six factors: coverage and benefits, provider choice, cost, customer service, information and communication, and billing and payment. On these measures, Highmark scored points out of 1, and came in third out of the top nine Medicare Advantage providers and just above the industry average [0] J.

Power Finds. Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.

Aetna Medicare Advantage plans. Anthem Medicare Advantage plans. Cigna Medicare Advantage plans. Humana Medicare Advantage plans. Kaiser Permanente Medicare Advantage plans. UnitedHealthcare Medicare Advantage plans. Wellcare Medicare Advantage plans. Highmark is the fourth-largest company in the Blue Cross Blue Shield family. Highmark offers health insurance for individuals and families, dental insurance, Medicare Advantage and Part D plans, Medicare Supplement Insurance, and other insurance coverage such as fertility treatment benefits and travel insurance.

The company also offers insurance for businesses. In , Highmark Health, the parent company of Highmark Inc. Here are some questions to consider asking:. Can you afford them? Is your doctor in-network? Are your prescriptions covered? What tier are your prescription drugs on, and are there any coverage rules that apply to them? Is there dental coverage?

Does the plan offer routine coverage for vision, dental and hearing needs? Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery? Highmark Medicare Advantage pros and cons. 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. Prescription Drug Information. Page Content. Managed Rx Coverage Program The managed prescription drug coverage MRxC program consists of online edits that encourage the safe and effective use of targeted medications to meet the clinical needs of members.

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

Manuals Highmark Provider Manual. Medical Injectable Drug Program. More information around Free Market Health List of drugs that are included in the program Below is the necessary information that should be provided on the prior authorization to limit and reduce the additional outreaches to the Provider's office.

Site Map Legal Information. This page gives you a brief overview of Highmark's Pharmacy Benefits Program and information on the following topics:.

Pharmacy Benefits for Managed Care Members Highmark administers prescription benefits for almost all members. For those members, the MedcoHealth logo appears on the member's ID card. Some direct pay benefit plans are not available in every region. All FreedomBlue coverage includes at least the same services as those provided by Medicare.

Most prescription drugs are covered when provided or authorized by the PCP on an outpatient basis and obtained at a Premier contracting pharmacy. The member must still pay applicable copayments. Mandatory Generic Feature Many plans include a mandatory generic provision, which requires that if the generic drug exists but the member or physician specifically requests the brand name drug, the member will have to pay the brand name copayment and the cost difference between the brand name drug and the generic drug.

For some plans with a mandatory generic provision, if a member requests the brand name drug, but the prescription does not specify "brand medically necessary," the member will be required to pay the difference in cost between the brand drug and the generic drug, in addition to the applicable brand name copayment. Coverage for Some Over-the-Counter Drugs Some over-the-counter medications are available through the closed formulary. 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.