Highmark: New Pharmacy Network for 2016

Effective Jan. 1, 2016, Highmark will be changing it’s three pharmacy networks.  Below is a summary of the changes that will be taking place for each of the major networks.

Premier is becoming National Plus network

  • This is Highmark’s broadest network that’s open to any pharmacy that agrees to our terms and pricing.
  • There will be no major changes for 2016, although some smaller independent pharmacies will no longer be in-network.

Premier 2012 is becoming National network

  • This broad network includes most large chain pharmacies, as well as many independent pharmacies.
  • The most significant change is that Target will be part of the National network. The impact of this is still unknown in light of the recent CVS acquisition of Target pharmacies. More details will be provided as they become available.
  • Some smaller independent pharmacies will no longer be in-network.

Focused is becoming Advantage network

  • Highmark anticipates that members in this network will experience the most disruption.
  • The most significant change is that Target and Rite Aid will be in-network and CVS and The Medicine Shoppe will no longer be in-network. Again, at this time we are not sure of the impact that the CVS acquisition of Target will have. We will provide more information as it becomes available.
  • Some smaller independent pharmacies will no longer be in-network.

How will members be affected?

It’s important to understand that members won’t have to go to their doctor for a new prescription if their pharmacy is no longer in the network. All members need to do is call or visit their new network pharmacy and provide the pharmacist with their information to transfer the prescription.

When will this be communicated to clients and members?

Highmark will be reaching out to clients starting in September to notify them about these changes. Members will receive notice about these changes in November 2015.

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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.