MMIT Payer Portrait: Highmark Health

Highmark Health is a privately owned not-for-profit subsidiary of Highmark, Inc., and a Blue Cross and Blue Shield licensee for its insurance offerings in Delaware, Pennsylvania, New York and West Virginia. It also participates on those states’ Affordable Care Act exchanges. Highmark’s offerings include commercial, Medicare Advantage and Medicaid products.

The company also operates Allegheny Health Network, a Western Pennsylvania-based health system of 13 hospitals and more than 250 sites of care. Highmark’s pharmacy benefits are managed by Express Scripts, while Gateway holds a PBM contract with DST Pharmacy Solutions. Much of its specialty pharmacy business is handled by AllianceRx Walgreens Prime, the specialty pharmacy partnership between Blues-owned Prime Therapeutics and Walgreen Co.

In March 2021, Highmark completed an affiliation deal with HealthNow New York Inc., bringing its two regional Blues brands under the Highmark umbrella. Gaining more than half a million members, the move also marks Highmark’s first forays into New York’s individual, group risk, Medicare Advantage and managed Medicaid markets. More recently, Highmark in June revealed it is one of the five Blues insurers backing patient-focused pharmacy startup Evio (see story, p. 1). The new company aims to lower the cost of prescription drugs and promote value-based, outcomes-focused contracting between payers, PBMs and manufacturers.

NOTE: Highmark Health, Gateway Health Plan and BlueCross BlueShield of Western New York and BlueShield of Northeastern New York are represented as separate entities in DHP.

SOURCE: AIS’s Directory of Health Plans; MMIT Analytics

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