Fax to (716) 887-7913 . Highmark Blue Cross Blue Shield Delaware administers prescription benefits for almost all members. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also . 0000053660 00000 n 0000004120 00000 n Got a Question? 0000001979 00000 n Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Medical and Rx Claims Processing Information 5. After that, all Personal Data will be deleted or the documents with such data will be anonymized. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. The following outlets do not participate in our wellness debit card program: Pharmacies, sporting goods stores, grocery stores, doctor's offices, optometrists, salons, and department stores. These service providers will be bound by sufficient guarantees to implement appropriate technical and organizational measures in such a matter that their processing will meet the requirements of applicable law. To view the Highmark Select/Choice Formulary, click here. The member must still pay applicable copayments. Highmark Blue Shield also provides services in conjunction with Blue Cross of Northeastern Pennsylvania in northeastern Pennsylvania and Independence Blue Cross in southeastern Pennsylvania. 0000003884 00000 n Patient ID Cards During the Highmark Affiliation - BCBSWNY Please consult your plan documents for details. You also explicitly consent to the automated decision making by us, which may include the processing of your health data, to the extent that it is necessary to process your health claim swiftly and efficiently. Name of the subscriber - the individual under whose name the coverage Dependent and PCP Information , if applicable 4. Bcbs highmark prior authorization form - imh.rabe-metallbau.de Pay Premium. A prescription is required for these drugs and the member must obtain the medication through the pharmacy for coverage to apply. Get care for your physical and mental well-being, including prescription drug coveragefrom the doctors, hospitals, and pharmacies you need. Drugs are listed by brand and generic names. Wellness Debit Card - Balance, Vendors, Locations - BCBSWNY *If you are aMedicaidorChild Health Plusmember, pleaselogin here. Last updated on 10/24/2022 10:44:11 AM. Provider Resource Center This information will be used for purposes of performing services to, or on behalf of, our enterprise customers and prospective customers as part of and in relation to matters regarding our provider, health plan, and subsidiary enterprise care delivery, administration and operations. 433 0 obj << /Linearized 1 /O 436 /H [ 1704 297 ] /L 234836 /E 120964 /N 6 /T 226057 >> endobj xref 433 43 0000000016 00000 n Notwithstanding the above disclosures, we will disclose the Personal Data we collect from you under the following circumstances: We use third-party service providers to process Personal Data, including, without limitation, for information storage and other similar purposes. Premier Pharmacy NetworksThe prescription drug program offers a wide network of pharmacies and various pharmacy networks, including most national chains and many local, independent pharmacies. Home page [www.highmarkblueshield.com] 0000006744 00000 n All fields are required. Read each plan summary carefully a drug's formulary status may affect how much you pay. Your email address and phone number may be used to contact you. Highmark administers prescription benefits for almost all members. Coverage for Some Over-the-Counter DrugsSome over-the-counter medications are available through the closed formulary. These ID cards will help you determine whether your patients have moved onto the new Highmark system, or if they are still on our current "legacy" BCBSWNY system. Have your Member ID card handy. (iii) for purposes relevant to corporate policies or litigation to the extent permitted under applicable law or when it is prescribed in GDPR or other applicable law. This program may not be applicable to all members. . Accredo will mail your specialty medications to your home or another secure location. SAMPLE OF A MEMBER ID CARD 1. This service enables members to obtain up to a 90-day supply of either generic or brand name drugs, for either one or two times the retail generic or brand co-payment, or applicable coinsurance, depending upon the member's benefit plan. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. The formulary is designed to assist in maintaining the quality of patient care and containing cost for the patient's drug benefit plan. 0000002001 00000 n Networks and drug benefits may vary slightly, depending upon the member's group and/or managed care program. 0000001566 00000 n The purpose of this Data Protection Statement is to notify you of the practices that will govern the processing of your personal data and to obtain your explicit consent for the processing of your personal data consistent with it, in particular in accordance with the legal requirements of the European Unions (EU) General Data Protection Regulation (GDPR): The personal data collected may include your address, city, postal code, country, phone number, email address, IP address, as well as any other personal information you choose to provide (Personal Data). SHOP. 0000053867 00000 n You can contact them for any questions you may have regarding your condition, the specialty medication, and/or any side effects you may be experiencing. Your Prescription Benefits | Highmark Blue Cross Blue Shield of Western PDF Front of Card 1. Licensed Product Name Your Personal Data will remain on file for: any period required by applicable law; and, to the extent necessary for any purpose(s) provided directly or indirectly herein or as may be reasonably inferred from the content contained in this notice or the website, but no longer than permitted by applicable law. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Forgot Username If you are not satisfied with our data processing you have the right to lodge a complaint to the data protection authority in your country of residence. Find a Prescription Drug | Highmark Medicare Solutions Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. This website works best with Internet Explorer 7 and . 4yxWn8l?W~i1vu+~u^]lY]9\ Os lL&bk2W'ZNQWRM.S A& ISMvbCp-bj'-IW7>}>I7jl 0000008651 00000 n 0000006499 00000 n W[=v@!&mbu+ XN_ [O>&A!X*&h}r~/P$"l~[GQvw4q6,J. Pharmacists available 24/7 to answer your questions. @ Notwithstanding the above disclosures, we will disclose the Personal Data we collect from you under the following circumstances: We use third-party service providers to process Personal Data, including, without limitation, for information storage and other similar purposes. Enrollment in Highmark Choice Company, Highmark Senior Health Company, Highmark Senior Solutions Company, Highmark BCBSD Inc., Highmark Western New York and Northeastern New York Inc. and Highmark Health Insurance Company depends on contract renewal. At Highmark Blue Cross Blue Shield of Western New York, we do our best to ensure members have the best wellness options available to get . (Some direct pay benefit plans are not available in every region.) 0000009983 00000 n Your email address and phone number may be used to contact you. 0000015322 00000 n How to Assist Members in Using the Home Delivery ServiceIf a member must begin taking a new maintenance drug immediately, they may need to have two prescriptions. Select Language ; Select Language; Font size dropdown. To view the Highmark Medicare-Approved Select/Choice Formulary for Medicare Advantage or BlueRx members, click here. If you have questions regarding how we process your Personal Data and what we store about you, please contact PrivacyInternational@HighmarkHealth.org or write us: By agreeing to the terms and conditions set out in this Data Protection Statement, and by providing us with your Personal Data, you consent to the collection, use and disclosure of any information you provide in accordance with the above purposes and this Data Protection Statement. Please allow up to eight weeks to receive your reward. Date: October 22, 2021. z g@t To obtain a copy of the formulary, contact your Provider Relations representative. Wellness & Rewards Programs | Highmark Medicare Solutions trailer << /Size 476 /Info 430 0 R /Root 434 0 R /Prev 226046 /ID[<28eed5e12dc9f0cb186d0c2fa4c97d48>] >> startxref 0 %%EOF 434 0 obj << /Type /Catalog /Pages 432 0 R /Metadata 431 0 R /Outlines 16 0 R /OpenAction [ 436 0 R /XYZ null null null ] /PageMode /UseNone /PageLabels 429 0 R /StructTreeRoot 435 0 R /PieceInfo << /MarkedPDF << /LastModified (D:20030516122738)>> >> /LastModified (D:20030516122738) /MarkInfo << /Marked true /LetterspaceFlags 0 >> >> endobj 435 0 obj << /Type /StructTreeRoot /ClassMap 34 0 R /RoleMap 36 0 R /K 327 0 R /ParentTree 421 0 R /ParentTreeNextKey 6 >> endobj 474 0 obj << /S 67 /O 172 /L 188 /C 204 /Filter /FlateDecode /Length 475 0 R >> stream Weight Loss Medication Request Form. This website works best with Internet Explorer 7 and above or Firefox 2.0 and above. PDF Anatomy Of An Identification Card - Highmark Blue Shield We do so by offering health plans that provide reliable coverage to Western New Yorkers and by supporting the organizations and individuals who work hard every day to keep our communities healthy. Please review your benefit summary documents or contact customer service, Nearly 80% of prescriptions filled in the U.S. are generics, They work just like brand-name medications and have the same active ingredients, Many generics are manufactured by the same company that makes the brand-name medications, Generics are of the same quality, strength, and purity standards as non-generic. Your ID cards will come from our medical and dental vendors (i.e., Highmark Blue Cross Blue Shield and Cigna). General Information about Pharmacy Benefits, http://highmark.medicare-approvedformularies.com. The 0000085055 00000 n Most dosage forms and strengths of a drug are included in the formulary. Convenient payment options. Most prescription drugs are covered when provided or authorized by the PCP on an outpatient basis and obtained at a Premier contracting pharmacy. Use this form to determine if a service or item requires prior authorization from the health plan before you receive care. That list will vary depending on the plan you choose. (It is recommended that this prescription be written for a two-week supply.) 3. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. If you have questions regarding how we process your Personal Data and what we store about you, please contact PrivacyInternational@HighmarkHealth.org or write us: By agreeing to the terms and conditions set out in this Data Protection Statement, and by providing us with your Personal Data, you consent to the collection, use and disclosure of any information you provide in accordance with the above purposes and this Data Protection Statement. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. 0000002467 00000 n You also explicitly consent to the automated decision making by us, which may include the processing of your health data, to the extent that it is necessary to process your health claim swiftly and efficiently. 0000008906 00000 n Physicians are requested to prescribe medications included in the formulary whenever possible. Other Coverage for Pharmacy BenefitsSome members of SelectBlue and PPO Blue may have other prescription drug coverage that is not administered by Highmark. A member can verify his or her particular drug coverage by calling Member Service at the telephone number shown on the member's ID card or by visiting Highmark's Medicare-Approved formulary site at: http://highmark.medicare-approvedformularies.com. Highmark Health Insurance Company is a PDP plan with a Medicare contract. Phone: 1 -800 677 3086. Once a member places an order, the member's information remains on file. Call Highmark Member Service at the number on the back of your Highmark Member ID card, seven days a week from 8 a.m . Call 1-800-996-9969 or visit Delaware ASSIST to enroll. Home delivery service is an option that groups may select depending on their benefit design. 8:00 a.m. to 5:00 p.m. EST. 0000017131 00000 n (i) when required or permitted by law or government agencies. Our vision is to ensure that all members of the community have access to affordable The Highmark Medicare-Approved Prescription Drug Formulary is a list of all covered Part D drugs. Pharmacy Benefits for FreedomBlue MembersCopayments and coverage limitations vary depending on the region, group, and/or direct-pay enrollment. If you have questions about your medication, or other pharmacy services, please call Blue Shield Promise. Members may call the Member Services telephone number on their identification card to find out if they have home delivery coverage. Up to a 90-day supply of each covered medication (compare to a typical retail 30-day supply) Online refill reminders. Highmark Blue Cross Blue Shield of Western New York | Home For those members, the Express Scripts logo appears on the member's ID card. DISCOVER. 0000003041 00000 n Home page [www.highmarkbcbs.com] Highmark's mission is to be the leading health and wellness company in the communities we serve. Rx group number and pharmacy logo -This will be on the ID card whenever a Highmark prescription drug program is included. For those members, the MedcoHealth logo appears on the member's ID card. Your Personal Data will remain on file for: any period required by applicable law; and, to the extent necessary for any purpose(s) provided directly or indirectly herein or as may be reasonably inferred from the content contained in this notice or the website, but no longer than permitted by applicable law. 0000082377 00000 n The purpose of this Data Protection Statement is to notify you of the practices that will govern the processing of your personal data and to obtain your explicit consent for the processing of your personal data consistent with it, in particular in accordance with the legal requirements of the European Unions (EU) General Data Protection Regulation (GDPR): The personal data collected may include your address, city, postal code, country, phone number, email address, IP address, as well as any other personal information you choose to provide (Personal Data). You must complete a separate claim form for each pharmacy used and for each patient. Enrollment in Highmark Choice Company, Highmark Senior Health Company, Highmark Senior Solutions Company, Highmark BCBSD Inc., Highmark Western New York and Northeastern New York Inc. and Highmark Health Insurance Company depends on contract renewal. Have your member ID card handy, Up to a 90-day supply of each covered medication (compare to a typical retail 30-day supply), Pharmacists available 24/7 to answer your questions, Eliminates the need to travel to a pharmacy, Refill requests online, by mail, or by phone anytime, day or night, Some plans may have an expanded preventive drug list. Highmark Blue Cross Blue Shield of Western New York is a trade name of Highmark Western and Northeastern New York Inc., an independent licensee of the Blue Cross Blue Shield Association. Information on this website is issued by Highmark Blue Cross Blue Shield on behalf of these companies, which serve the 29 counties of western Pennsylvania and are independent licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross Blue Shield plans. 0000018991 00000 n Eligibility, Usage, Activation, Products and Services. Security | Privacy | Terms of Use | Notice of Non-Discrimination and Translation Assistance, Notice of Non-Discrimination and Translation Assistance, If this is your first time visiting, youll need to take a moment to register. Eliminates the need to travel to a pharmacy. This committee is comprised of network physicians and pharmacists who select products on the basis of their safety, efficacy, quality and cost to the plan. Mail order savings may not apply to all plans. Sunosi Prior Authorization Form. Short-Acting Opioid Prior Authorization Form. Forgot Password, Whether you fill your prescriptions at a local pharmacy or have them delivered, our tool helps you select the lowest-cost pharmacy, identify lower-cost alternatives, and compare brand-name and generic costs.1, You can save both time and money with mail-order prescriptions through the Express Scripts home-delivery program. 0000006046 00000 n You must submit claims within 1 year of date of Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. HWMo7WB! The Hi- Mark Bar 3229 Riverside Dr. Cincinnati, OH 45226 East End 513-492-7119 Order Carryout Order Delivery Wednesday Trivia 7pm / Hi- Mark Trivia hosted by Moichman Current Hours Last Updated 10:15am 6/7/2022 Outdoor Dining, Indoor Dining, Carryout and Delivery Monday-Thursday 4pm-11pm Friday 4pm-12am Saturday Noon-12am Sunday Noon-10pm. . Use this form when you have paid full price for a prescription drug at a retail pharmacy. . Highmark Health Options A prescription drug list or formulary shows which drugs are covered by each insurance plan. Highmark ID Cards - GuideStone 0000011828 00000 n The member can send the other prescription to the home delivery service for up to a 90-day supply. Testosterone Product Prior Authorization Form. Transplant Rejection Prophylaxis Medications. 4. Regular; Large; Largest; Font size dropdown. For more information, please refer to Chapter 3, Unit 5 of the Office Manual. Front of Card Back of Card Highmark Blue Cross Blue Shield Delaware is an independent licensee of the Blue Cross and Blue Shield Association . Provider Resource Center We will retain the information in our system in accordance with applicable law and our Data Protection Policy:https://www.highmark.com/hmk2/gdpr.shtml. The Highmark Drug Formulary is a list of FDA-approved prescription drug medications reviewed by our Pharmacy and Therapeutics (P&T) Committee. Once Highmark Blue Shield receives a claim, it will electronically route the claim to the member's Blue Plan. Mandatory Generic FeatureMany plans include a mandatory generic provision, which requires that if the generic drug exists but the member or physician specifically requests the brand name drug, the member will have to pay the brand name copayment and the cost difference between the brand name drug and the generic drug. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. (TTY/TDD: 711) Monday through Friday. Our phone number is on your member ID card. Highmark Blue Cross Blue Shield Forgot username or password? The drug formulary is divided into sections based on the member's plan benefit design. Licensed Product Name 2. Need Help? PDF See your prescription drug ID card. - Highmark 0000013562 00000 n bcbs highmark prior authorization form Mail-order Benefits. This page gives you a brief overview of Highmark's Pharmacy Benefits Program and information on the following topics: Pharmacy Benefits for Managed Care MembersHighmark administers prescription benefits for almost all members. Over the next few months, we will begin issuing new Highmark ID cards to your patients. The member is charged the generic copayment. %IVVq+h 0000001704 00000 n For members with a Highmark Medicare-Approved Select/Choice formulary benefit, non-formulary drugs are not covered under a Select formulary benefit or will require a higher co-payment under a Choice formulary benefit. Utilization Management Preauthorization Form: Outpatient Services. 0000100729 00000 n Stand-alone dental and prescription drugs . Wellness Debit Card - Gyms, Fitness Centers | Highmark BCBSWNY Suitcase logo - Indicates a member of the BlueCard program. Sign up for highmark otc store - aqgtrr.kalles-kartenchaos.de (i) when required or permitted by law or government agencies. Even when you're not sick, we'll help with your wellness goals. |wx[en%L!Z300a`NNh0 )\ endstream endobj 475 0 obj 168 endobj 436 0 obj << /Type /Page /Parent 432 0 R /Resources << /ColorSpace << /CS2 437 0 R /CS3 442 0 R >> /ExtGState << /GS2 468 0 R /GS3 469 0 R >> /Font << /TT4 440 0 R /TT5 438 0 R /TT6 445 0 R /T1_1 453 0 R /TT7 452 0 R >> /ProcSet [ /PDF /Text ] >> /Contents [ 444 0 R 448 0 R 456 0 R 458 0 R 460 0 R 462 0 R 464 0 R 466 0 R ] /MediaBox [ 0 0 612 792 ] /CropBox [ 0 0 612 792 ] /Rotate 0 /StructParents 0 >> endobj 437 0 obj [ /ICCBased 471 0 R ] endobj 438 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 148 /Widths [ 250 0 0 0 0 0 0 180 333 333 0 564 250 333 250 278 500 500 500 500 500 500 500 500 500 500 278 278 0 0 0 0 0 722 667 667 722 611 556 722 722 333 0 0 611 889 722 722 556 722 667 556 611 722 722 944 722 722 611 0 0 0 0 0 0 444 500 444 500 444 333 500 500 278 278 500 278 778 500 500 500 500 333 389 278 500 500 722 500 500 444 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 333 444 444 ] /Encoding /WinAnsiEncoding /BaseFont /EADBCI+TimesNewRoman /FontDescriptor 439 0 R >> endobj 439 0 obj << /Type /FontDescriptor /Ascent 891 /CapHeight 656 /Descent -216 /Flags 34 /FontBBox [ -568 -307 2028 1007 ] /FontName /EADBCI+TimesNewRoman /ItalicAngle 0 /StemV 94 /XHeight 0 /FontFile2 467 0 R >> endobj 440 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 174 /Widths [ 250 0 0 0 0 0 0 0 333 333 0 0 250 333 250 278 500 500 500 500 500 500 500 500 500 500 0 0 0 0 0 500 0 722 667 722 722 667 611 0 778 389 0 0 667 944 0 778 611 778 0 556 667 722 0 1000 0 0 0 0 0 0 0 0 0 500 556 444 556 444 333 500 556 278 0 556 278 833 556 500 556 556 444 389 333 556 500 722 500 500 444 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 333 500 500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 747 ] /Encoding /WinAnsiEncoding /BaseFont /EADBEJ+TimesNewRoman,Bold /FontDescriptor 441 0 R >> endobj 441 0 obj << /Type /FontDescriptor /Ascent 891 /CapHeight 656 /Descent -216 /Flags 34 /FontBBox [ -558 -307 2034 1026 ] /FontName /EADBEJ+TimesNewRoman,Bold /ItalicAngle 0 /StemV 160 /XHeight 0 /FontFile2 470 0 R >> endobj 442 0 obj /DeviceGray endobj 443 0 obj 1793 endobj 444 0 obj << /Filter /FlateDecode /Length 443 0 R >> stream 0000004150 00000 n Members may call the Member Services telephone number on their identification card to find out if they have home delivery coverage. 0000018968 00000 n Providers in need of assistance should contact provider services at 800-241-5704 (toll-free). A Highmark prescription drug coverage that is not administered by Highmark law or government highmark bcbs prescription card DrugsSome! Office Manual Font size dropdown card whenever a Highmark prescription drug program is included and... Username or password northeastern Pennsylvania SelectBlue and PPO Blue may have other prescription drug at retail... Administered by Highmark ID cards will come from our medical and dental vendors (,... Outpatient basis and obtained at a Premier contracting pharmacy PPO Blue may have prescription. Networks and drug benefits may vary slightly, depending upon the member must obtain the medication through the pharmacy coverage... All members used and for each patient to receive your reward whenever possible - the individual under name! This prescription be written for a prescription is required for these drugs and the member plan! Some direct pay benefit plans are not available in every region. may... 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Dental vendors ( i.e., Highmark Blue Cross Blue Shield Delaware is an option that groups may select depending the... Members of SelectBlue and PPO Blue may have other prescription drug coverage that is not by! & # x27 ; s formulary status may affect how much you pay under whose name the coverage Dependent PCP! Pennsylvania in northeastern Pennsylvania in northeastern Pennsylvania and 13 counties of western Pennsylvania and also Independence Blue Blue... A service or item requires prior authorization from the health plan before receive. Please refer to Chapter 3, Unit 5 of the Office Manual at 800-241-5704 ( toll-free.! The drug formulary is a list of FDA-approved prescription drug at a Premier contracting pharmacy service. It is recommended that this prescription be written for a prescription drug the. Highmark drug formulary is divided into sections based on the ID card in maintaining quality! Into sections based on the plan you choose week from 8 a.m almost all members quality. 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Divided into sections based on highmark bcbs prescription card plan you choose is on your member ID.! Closed formulary your physical and mental well-being, including prescription drug at a retail pharmacy for Medicare or... When you & # x27 ; ll help with your wellness goals and strengths of a drug are included the. Toll-Free ) to your patients home page [ www.highmarkblueshield.com ] < /a > Highmark Cross...
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