Highmark Blue Cross Blue Shield West Virginia has a streamlined program for the provision of medical benefit specialty drugs called the Medical Injectable Drug program or MID program. Drugs designated as mandatory MID drugs must be obtained from Walgreens Specialty Pharmacy for in-office administration. If a drug has been designated as a voluntary MID drug, there is no requirement to obtain the drug from Walgreens Specialty. In the case of voluntary MID drugs, network physicians can obtain the drug from Walgreens Specialty Pharmacy or another one of Highmark’s contracted specialty pharmacy providers. Network physicians can also choose to buy and bill voluntary MID drugs, in which case reimbursement will be governed by previous bulletin communications.
The mandatory MID program is applicable to the following Highmark Blue Cross Blue Shield West Virginia lines of business: PPO, EPO, HMO, POS and Medicare Advantage. The voluntary MID program is applicable to all of the products listed above, in addition to the Federal Employee Program (FEP) and Bluecard network claims. The MID program does not apply to traditional or indemnity products.
Walgreens Specialty Pharmacy is open seven days a week and offers several delivery options, clinical expertise and a dedicated financial assistance team. Walgreens Specialty Pharmacy can be reached at 1-888-347-4894. The Walgreens Specialty Pharmacy fax number for the Pittsburgh location is 1-844-394-4200. When a specialty drug is fulfilled by Walgreens Specialty Pharmacy, Walgreens bills Highmark for the drug and ships the drug to the medical provider for administration. Financial assistance resources are available to help patients who qualify. (Please note: If a patient seeks financial assistance, this can delay delivery of the drug.)
Below is the necessary information that should be provided to Walgreens Specialty Pharmacy to limit and reduce the additional outreaches to the Provider's office.
- Patient name, address, DOB
- Date needed
- Diagnosis code in ICD10 format
- Patient weight
- Prescription Insurance Information
- Drug name and strength
- MD Signature, address, and contact information
- Date written
- Allergies, Medical conditions, and concurrent medications
- Prior authorization numbers or information if already obtained
- Any other additional information required on the therapy/drug specific referral form
Last updated on 7/20/2018