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This email is intended to producers with business in New York.
Introducing Highmark's Specialty Drug Management Arrangement Powered by Free Market Health to the New York Market
Why am I receiving this?
Highmark is excited to announce the expansion of our specialty pharmacy arrangement powered by Free Market Health into the New York Market. We’ve had this model in place with our large group fully-insured and Medicaid books-of-business in Pennsylvania and Delaware since 2021. During that time, we evaluated the performance of this value-based specialty pharmacy solution and made adjustments to maximize efficiency, savings and the clinical needs of our members. We are confident that this is the right approach to take, which is why we’re introducing it to include our New York Market
What do I need to know?
- Highmark's specialty pharmacy arrangement powered by Free Market Health is designed to bring members an enhanced clinical approach to the management of their specialty medication while containing the cost of the drug.
- Highmark is expanding the reach of our specialty pharmacy arrangement powered by Free Market Health to include the New York market with the following effective dates:
- July 1, 2024:
- New York Fully-Insured Individual ACA
- August 1, 2024:
- New York Fully-Insured Large Group & Grandfathered (including Article 47 ASO, ASC)
- New York Fully-Insured Small Group ACA
- January 1, 2025:
- New York Large Group ASO (except Article 47) & TPA
- Since SaveOnSp is exclusive to Accredo Specialty Pharmacy, it will no longer be an option after transitioning to Free Market Health. ASO Clients in New York that have SaveOnSp in place today will be transitioned to Highmark’s Copay Armor program, powered by PillarRx.
Read all about it here. Or skip right to the Brainshark or member and provider letters (make sure to use the drop down box to access both!).
What do I need to do?
No action is required for Individual, Small Group and Fully-Insured customers. ASO clients must make a decision by August 31, 2024 on whether or not to adopt the Free Market Health solution for a January 1, 2025 effective date or continue with their existing specialty arrangement.
Still Have Questions?
Please reach out to your Sales Executive or Client Manager. |
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Benefits and/or benefit administration may be provided by or through the following entities, which are independent licensees of the Blue Cross Blue Shield Association:
Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company.
Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company.
PA: Your plan may not cover all your health care expenses. Read your plan materials carefully to determine which health care services are covered. For more information, call the number on the back of your member ID card or, if not a member, call 866-459-4418.
Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.
West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Visit https://www.highmarkbcbswv.com/networkaccessplan to view the Access Plan required by the Health Benefit Plan Network Access and Adequacy Act. You may also request a copy by contacting us at the number on the back of your ID card.
Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield.
Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.
Highmark Blue Cross Blue Shield and Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with a Medicare contract. Enrollment in these plans depends on contract renewal.
All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.
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This email and any attachments contain important information about Highmark, including its products, customers and business
processes, and may include information which Highmark considers to be confidential and proprietary ("the Highmark Information").
The Highmark Information is intended solely for the use of the individual or entity to which it is addressed, including employees of that
entity with a need to access such information. Unauthorized use, disclosure or copying of the Highmark Information, including the
posting of such information on a website or social media sites that can be accessed by third parties, is strictly prohibited.
® Highmark is a registered mark of Highmark Inc.
© 2016 Highmark Inc., All Rights Reserved
120 Fifth Avenue Pittsburgh, PA 15222 USA
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