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This email is intended for producers with group business in Delaware, New York, Pennsylvania, and West Virginia.
Pharmacy Blast: Introducing EnReachRx
What do I need to know?
Highmark is introducing EnReachRx, a high-touch, integrated patient support model designed by Express Scripts to address rising costs, reduced access, and adherence challenges of GLP-1 medications. This program is administered through specific mail order and retail pharmacies and changes the pricing structure for GLP-1s.
Through the EnReachRx program, members will have consistent access to injectable GLP-1 medications that are FDA-approved for type 2 diabetes and weight-loss (where covered). These medications will be administered through the following arrangements:
- EnGuide Pharmacy, a GLP-1 specific mail-order pharmacy that began dispensing medications in June 2025 and was communicated here: Express Scripts Launching EnGuide Pharmacy for GLP-1s.
- Retail Participating Partners, specific retail pharmacies where members can also access GLP-1 medications through EnReachRx. Currently, Costco and Walgreens pharmacies are considered Retail Participating Partners.
In addition to providing our members with guaranteed access to GLP-1s, EnGuide Pharmacy and Retail Participating Partner pharmacies offer enhanced clinical care and patient support effective September 1, 2025. This includes pharmacist and clinician coaching, dose optimization support to help patients reach therapeutic level and manage side effects, regular clinical assessments, coordination of care across the patient journey, and digital tools for GLP-1 patient education.
For clients with guarantees in place, there will be a separate GLP-1 discount guarantee for prescriptions filled at EnReachRx pharmacies effective January 1, 2026 upon a client’s financial renewal. Current guarantees will not be impacted until that time. There will be no added professional service fees or shipping fees.
What do I need to do?
Action is needed for any ASO client that wants to opt-out of the EnReachRx program. The ASO Opt-Out Amendment was provided to all ASO clients and reflects program benefits, rebate reconciliation changes, and discount guarantee changes. ASO clients that want to opt-out for January 1, 2026 must communicate by September 10, 2025.
Please note, if an ASO client chooses to opt-out, the client’s employees and their families will not have access to EnReachRx pharmacies for the impacted GLP-1 medications. This includes weight loss GLP-1 medications (where covered) and diabetic GLP-1 medications.
No action is needed for ASO clients who want to remain in the EnReachRx program, or fully insured clients. The EnReachRx program will automatically be applied.
Questions?
The below FAQs were created for your use.
- EnReachRx FAQs Blue Cross Blue Shield branded for your use in Delaware, Northeastern and Western Pennsylvania, West Virginia, and Western New York
- EnReachRx FAQs Blue Shield branded for your use in Central and Southeastern Pennsylvania, and Northeastern New York
Prior producer blasts regarding GLP-1 coverage and utilization management are also included for your reference.
Please contact your Sales Executive or Client Manager with any additional questions.
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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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