Highmark provides members alternative sites of care for infusion therapies

PITTSBURGH, Pa. (Dec. 4, 2018) — At Highmark, we believe we have to put patients first. So we're rethinking what a health insurance company can do, teaming up with doctors and hospitals, making the best care more convenient, and finding ways to save you money while keeping you healthy.

With Highmark, your medical and prescription drug coverage is combined. This gives you another layer of protection, as it allows us to double-check that every prescription you fill is the safest, most effective medication available. We can also help you save by alerting your doctor if there's a more affordable prescription on the market.

One area we are focusing on is infusion drug treatment programs, which are historically administered in higher cost settings like the hospital outpatient setting. Starting January 1, 2019, Highmark Inc. will expand this option by providing safe and effective alternatives for those currently receiving infusion therapies in higher cost sites of care.

As part of a newly-introduced site of care program from Highmark's pharmacy team, members will be able to receive infusion therapies in their home, doctor's office or at an infusion suite, pending a prior authorization process.

"By receiving infusion therapies at other sites, members can reduce transportation times, see more flexibility in their schedules and receive their treatment in a more comfortable and private environment. However, if a hospital setting is the appropriate option, a member's care will continue to be covered and uninterrupted," said Sarah Marché, Pharm. D., Vice President, of Pharmacy Services for Highmark Inc. "The bottom line is that we are helping to ensure that drugs are being infused in the most clinically appropriate, cost effective site of care."

Initially, this change will be applicable for fully-insured commercial members in all regions of Highmark's core insurance markets including Pennsylvania, West Virginia and Delaware and national customers. Self-funded groups may elect to apply this change.

"This program's primary goal is to provide better healthcare experiences for our members through the expansion of choice and access. To that end, we also work closely with our aligned clinical partners to ensure our program's structure meets their needs while still reducing the total cost of care," Marché continued.

Site of care currently applies to a subset of the drugs administered, including drugs that treat such issues as Rheumatoid Arthritis, immune deficiency diseases, Ulcerative Colitis, Crohn's Disease and other chronic diseases, which are often conditions that need lifetime treatment.

All of the drugs in the program were clinically evaluated to verify they can be given with the same level of safety by a non-hospital provider. Members taking advantage of alternative sites of care will be able to choose from a vast network of home infusion therapy providers that ensures access for all Highmark's members.

"This is the latest milestone in our ongoing vision to make healthcare experiences more accessible, affordable and closer to home. By introducing this policy, we're confident that more patients with chronic conditions will be able to resume more of their lifestyle and get back into the normalcy of their routines," Marché said.