Program for Self-Administered Injectable or Oral Biotechnology Drugs

In recent years, Highmark Delaware 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 patients. A key component of this program has been the use of AllianceRx Walgreens Prime (previously Walgreens Specialty Pharmacy).

Effective July 1, 2017, Highmark Delaware also has a program for self-administered injectable or oral biotechnology specialty drugs. Members who use these specialty drugs can obtain them from 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 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.

  • Retail exclusivity list of drugs that will be provided by AllianceRx Walgreens Prime. This pertains to commercial business only for groups taking this benefit.

Attain a copy of the Specialty Medication Request Form if needed.

Last updated on 11/6/2018

 

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