Specialty Drug Program

(Self-Administered Injectable or Oral Biotechnology Drugs)

In recent years, Highmark has taken steps to help manage the rising costs of medications. For example, we have a streamlined program for physicians through which they can order certain injectable drugs for their Highmark patients. A key component of this program has been the use of AllianceRx Walgreens Prime (previously Walgreens Specialty Pharmacy) and effective January 1, 2016 select members can utilize Giant Eagle Specialty Pharmacy. (See paragraph below for details.)

Members who use these specialty drugs can obtain them from AllianceRx Walgreens Prime. These drugs are not covered if obtained at a retail pharmacy or via mail order service+.

NOTE:
+Medicare Advantage members may continue to obtain these drugs at a retail pharmacy or through mail order service.

Due to Medicare Part D prescription drug coverage regulations, the program is not mandatory for Medicare Advantage patients. However, Medicare Advantage patients still have the option to obtain their specialty drugs through AllianceRx Walgreens Prime.

This program is designed to:

  • enhance integrated care and utilization management for patients who use these drugs
  • ensure the drugs are administered in the most appropriate and effective manner
  • simplify the precertification process for these medications
  • reduce costs by minimizing waste

Reducing Costs by Minimizing Waste
In addition to obtaining these drugs exclusively through AllianceRx Walgreens Prime, the member's retail pharmacy supply limit (usually a 30-day or one-month supply) and cost-sharing also apply as specified in the member's existing prescription drug benefit design. In the past, many patients found they could not tolerate these drugs and, therefore, many dosages were not used. This program greatly reduces the amount of unused dosages of these medications, some of which can cost as much as thousands of dollars per month.


AllianceRx Walgreens Prime is open seven days a week and offers several delivery options as well as patient counseling and monitoring of your refill needs. AllianceRx Walgreens Prime can be reached at 1-888-347-3416 or 412-231-3777. The AllianceRx Walgreens Prime fax number for the Pittsburgh location is 877-235-9807.

  • Retail exclusivity list of drugs that will be provided by AllianceRx Walgreens Prime. This pertains to commercial business only for groups taking this benefit.
  • Below is the necessary information that should be provided to AllianceRx Walgreens Prime 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
    • Directions
    • Quantity
    • Refills
    • 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

If you need more information than what is provided above, please contact AllianceRx Walgreens Prime at 888-347-3416.


Giant Eagle Specialty Pharmacy

Giant Eagle Specialty Pharmacy offers the self-administered injectable or oral biotechnology drugs listed below for in-store pickup at any location in our service regions. In addition, Giant Eagle Specialty Pharmacy can provide Highmark patients in the above-mentioned products with face-to-face pharmacist counseling, in-store administration training, therapy adherence support and refill follow-up.*

*Member benefits may vary. As always, verify members’ benefits prior to service. You can do this through the Eligibility and Benefits function on NaviNet®.

Although the drugs listed below can be obtained from Giant Eagle Specialty Pharmacy, Highmark patients in the above-mentioned products can continue to get these drugs from AllianceRx Walgreens Prime as they do today.

 If you need more information than what is provided above, please contact Giant Eagle Specialty Pharmacy at 1.844.259.1891, Option 1.

Last updated on 11/1/2018

 

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