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This email is intended for producers in western Pennsylvania, central Pennsylvania, northeastern Pennsylvania, Delaware, and West Virginia* HIGHMARK TO OFFER NEW PHARMACY PROGRAM - COPAY ARMOR, EFFECTIVE JANUARY 1, 2021 As a producer partner, we want to continue to arm you with the tools and resources you need to support your clients. We hope that you find the presentation to be informative and helpful as we launch this exciting new program into the market. Please find below the links to the webinar recording and slide deck.
Effective January 1, 2021, to help reduce/eliminate costs for our members, Highmark and PillarRx have worked together to create the Copay Armor Discount Coupon product for our members. This product will take high cost medications (mostly specialty) and leverage manufacturer coupon dollars to lower the price for members enrolled in one of the following plans:
- Large group
- Cost plus
- Small group grand mothered, pre-Affordable Care Act (ACA)
- Administrative Services Only (ASO)
- *Product is available to West Virginia ASO only.
How the Product Works When a provider prescribes a drug for one of the medications listed on the Copay Armor Drug List, the primary claim will process the member cost share at 30%. Most of these drugs are subject to prior authorization requirements that will need to be submitted for approval to Highmark.
Once the prior authorization is submitted and approved, PillarRx will enroll the patient in the program and contact the pharmacy with the secondary billing information. They will then work with the pharmacy to apply the manufacturer assistance/coupon to the secondary claim.
After primary and secondary claims are submitted, the member’s copay will be zero or require a minimal amount to be paid by the member (i.e. $5). If there is a copay that needs to be paid, the member will submit that payment to the pharmacy provider dispensing the medication.
The drugs in scope for the Copay Armor program are subject to change and will be reviewed by the Highmark Pharmacy team for updates biannually.
What does this mean for fully insured clients? The Copay Armor program will be rolled out to all groups in scope upon renewal starting 1/1/2021.Highmark in collaboration with Pillar Rx, the vendor providing the back end services, will ensure that members who qualify for this program are outreached to via member letter as well as a phone call for enrollment.
What does this mean for ASO clients? The Copay Armor program will be available to ASO clients as an opt in option. For self-funded business there is a shared savings fee of 25%. The fee is defined as administrative covering the cost of the vendor working with the member and the dispensing pharmacy to utilize the available manufacturer dollars for the applicable medication(s). Highmark in collaboration with Pillar Rx, the vendor providing the back end services, will ensure that members who qualify for this program are outreached to via member letter as well as a phone call for enrollment.
The Value
Plan Sponsor
- Increased coinsurance to help offset costs for expensive medications
- PillarRx’s professional staff to supplement Plan’s support for patients that have complicated conditions
- Enhanced benefit management for patients and their families
- Efficient delivery of needed medications to Plan patients
- Maintained integrity of Plan’s intended plan design(s)
Patient
- Reduction in actual out-of-pocket cost for the most expensive medications
- Personalized service
- Gain advocates to communicate and coordinate with
- Drug manufacturers
- PBM’s
- The providing pharmacy
- Proactive support and assistance throughout the patient’s treatment period
If you have questions, please contact your Highmark Client Manager or Sales Executive.
PLEASE NOTE: PPO groups only are in scope effective 1/1/2021 with QHDHPs anticipated to be in scope mid-year 2021. |
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Highmark Inc. is an independent licensee of the Blue Cross Blue Shield Association. Insurance or benefit administration may be provided by or through Highmark Inc. or one of its affiliated Blue companies. Highmark Inc. d/b/a Highmark Blue Shield and certain of its affiliated Blue companies serve Blue Shield members in the 21 counties of central Pennsylvania. As a partner in joint operating agreements, Highmark Blue Shield also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Inc. or certain of its affiliated Blue companies serve Blue Cross Blue Shield members in the 29 counties of western Pennsylvania, 13 counties in northeast Pennsylvania, the state of West Virginia plus Washington County, Ohio, and the entire state of Delaware. |
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