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Highmark BCBS Group Insurance Update

On January 1, 2019, Highmark will launch the Site of Care Drug Management Program. This program benefits your business by helping to address the rising cost of certain specialty drugs. The program focuses on a subset of specialty drugs which are typically administered in a hospital outpatient department or other hospital-affiliated site but may be administered in an alternative, medically appropriate, lower cost site of care. 

Highmark currently employs prior authorization with an associated medical policy to ensure that the drugs are being utilized appropriately. When the Site of Care Drug Management Program goes into effect in 2019, Highmark will revise the existing medical policy to incorporate a medical necessity review for the requested site of care. This will help to ensure that high-cost hospital-affiliated sites are approved in cases where clinical documentation shows that the member is medically unstable for infusions in a setting other than a hospital-based setting. If medically appropriate, members can receive these infusible drugs in a more convenient, less costly, alternative setting such as the home, a doctor’s office (non-hospital affiliated) or an infusion suite (non-hospital affiliated). 

Here are some advantages:

  • Benefits to the member include enhanced privacy, reduced travel time, scheduling flexibility and reduced risk of exposure to hospital and clinic-acquired illnesses
  • Switching members from facility-based care to safe, alternative sites of service can result in cost savings for employers and their employees
  • During the prior authorization process, Highmark’s clinical team reviews the prescriber’s request to help make sure that the recommended site of care is medically appropriate based on the member’s specific clinical situation
  • All of the drugs in the program were clinically evaluated for safety in non-
  • hospital settings

To learn more about the Site of Care Drug Management Program, please contact Songer Insurance Agency in Beckley WV, we service all size group health insurance plans. We work with most health Insurance companies in West Virginia, so we are able to find what the best option is for you and your company. We are located at 2955 Robert C. Byrd Dr. Beckley WV 25801. Our telephone number is 304-252-656