highmark medco formulary
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Learn More. The Peer-to-Peer request must be received by Maryland Amerigroup maryland prior authorization Care within two 2 business days of the initial notification of the denial. The intent of the Peer-to-Peer is to discuss the denial decision with the ordering clinician or attending physician. For specific details prioe authorization requirements, please refer to our Quick Reference Guide. Certain carefirst mental providers require prior authorization regardless of place of service.

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Highmark medco formulary

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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.

Any subsequent refills do not require an order form. For refills, the member can call the toll-free number, send in the refill form with the applicable co-payment, or visit Highmark's web site at www. Contact Us. Provider Directory. 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.

Any subsequent refills do not require an order form. For refills, the member can call the toll-free number, send in the refill form with the applicable co-payment, or visit Highmark's web site at www.

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. Requiring Authorization.

Pharmacy Policy Search. Message Center. Manuals Highmark Provider Manual.

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How to Complete the Prescription Drug Template

Dec 31, †∑ This site works best with the latest version of Edge, Firefox, Chrome or Safari. Highmark Choice Company, Highmark Senior Health Company, Highmark Senior Solutions . A formulary is the list of generic and brand-name prescription drugs covered by your plan. Drugs that do not appear on the formulary are not covered. The formulary will also tell you: What . Alternative Therapy Analgesic, Anti-Inflammatory Or Antipyretic Anesthetics Anorectal Preparations Antidotes And Other Reversal Agents Anti-Infective Agents Antineoplastics .