WebFor other helpful information, please visit the Highmark Web site at: www.highmark.com MM-060 (R9-05) Specialty Drug Request Form Once completed, please fax this form to1-866-240-8123. To view our formularies on-line, please visit our Web site at the addresses listed above. Please use a separate form for each drug. WebJan 9, 2024 · Some drugs require authorization before they will be covered by the pharmacy benefit program at the point of sale. Highmark members may have prescription drug …

highmark.medicare-approvedformularies.com Specialty Drug …

WebUtilization Management Preauthorization Form: Outpatient Services Fax to (716) 887-7913 Phone: 1 -800 677 3086 To facilitate your request, this form must be completed in its entirety. Patient Information Patient name Patient date of birth Patient ID # with prefix Patient diagnosis code Comorbidities head of the river oxford pub

Name of Requestor/Contact Person:

WebHighmark Inc. or certain of its affiliated Blue companies also serve Blue Cross Blue Shield members in 29 counties in western Pennsylvania, 13 counties in northeastern … WebPlease note that the drugs and therapeutic categories managed under our Prior Authorization and Managed Prescription Drug Coverage (MRXC) programs are subject to change based on the FDA approval of new drugs. Highmark Blue Shield and Highmark Health Insurance Company are independent licensees of the Blue Cross and Blue Shield … WebHighmark requires authorization of certain services, procedures, and/or Durable Medical Equipment, Prosthetics, Orthotics, & Supplies ( DMEPOS) prior to performing the … head of the schuylkill 2023