Does Highmark cover prescriptions?
In most cases, your prescriptions are covered under your Highmark plan only if they are filled at a network pharmacy or through our mail-order pharmacy service. A network pharmacy is a pharmacy that has agreed to provide prescription drug benefits at negotiated prices for Highmark members.
What is a drug benefit formulary?
A formulary is an evolving list defining the prescription drugs to be covered under your company’s benefit program.
What specialty pharmacy does Highmark use?
If approved, Highmark will forward to Walgreens Specialty Pharmacy, LLC., our specialty vendor. Walgreens Specialty Pharmacy can be reached at 888-347-3416.
What mail order pharmacy does Highmark use?
Express Scripts
Welcome! We’re proud that Highmark has chosen Express Scripts to help administer your prescription drug benefit for mail-order services. You’re now with the industry leader. Express Scripts has provided quality prescription drug benefit services to millions of Americans for over 30 years.
How do drugs get on formulary?
Typically, a team of medical professionals approves the drugs on a health plan’s formulary based on safety, quality, and cost-effectiveness. The team is made up of pharmacists and physicians who review new and existing medications. Sometimes health plans choose not to cover a prescription drug.
How do you get a drug on formulary?
Share your formulary with your physician. Ask for a prescription from your list that best meets your treatment needs. Ask about generics. Explore the generics or tier 1 and tier 2 drugs on your formulary with your doctor.
What does formulary drugs mean?
Drug Formulary Law and Legal Definition. Drug formulary refers to the list of prescription medications or pharmaceutical products developed and approved by each health plan to encourage greater efficiency in the dispensing of prescription drugs without sacrificing quality.
Can my drug formulary change?
A formulary may change when a new more cost-effective prescription drug comes to market or when new safety information about a prescription drug is released. Sometimes a plan will let you continue to fill prescriptions for a prescription drug removed from the formulary throughout the period of the coverage year if you are already taking it.
Who makes drug formularies?
In most health plans, the formulary is developed by a pharmacy and therapeutics committee composed of pharmacists and physicians from various medical specialties (this is required for prescription drug coverage under ACA-compliant individual and small group health plans as of 2017). 1
What is the drug formulary?
A drug formulary is a list of prescription drugs, both generic and brand name, used by practitioners to identify drugs that offer the greatest overall value. A committee of independent, actively practicing physicians and pharmacists maintain the formulary. The formulary can change from time to time.