Highmark: Active Choice Home Delivery

Beginning January 1, 2016, Highmark together with Express Scripts will implement an Active Choice Home Delivery program for members in certain market segments filling maintenance prescription drugs. Maintenance prescription drugs are considered those taken on a regular basis and are appropriate for a 90-day supply.

Under the Active Choice program, a member must declare a choice to have their maintenance prescriptions filled either by home delivery through Express Scripts PharmacySM, or to pick up their prescriptions at a local retail pharmacy.

Members have up to two fills at a retail pharmacy before they are required to make their choice. By the 3rd fill, the member will need to make a decision, or pay 100% of the drug cost. They will continue to pay 100% of the cost until their choice is made.

Highmark members impacted include:

  •  All PA Individual Market Affordable Care Act (“ACA”) members
  •  All PA Small Group ACA members upon contract renewal
  •  New to Highmark PA Small Group ACA members

There is no penalty if members choose to continue to refill their maintenance prescription drugs through a retail pharmacy, and members can change their preference of retail pharmacy fills or mail order delivery at any time by contacting Express Scripts. Members will continue to get short-term medications, such as antibiotics, from participating retail pharmacies – no choice is required for short-term medications.

 

DISCLOSURE

The information provided herein is intended solely for the use of our clients. You may not display, reproduce, copy, modify, license, sell or disseminate in any manner any information included herein, without the express permission of the Publisher or Publishers of articles within.

The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.