Important Information Regarding 2025 Formulary Changes

Highmark Blue Shield pharmacy services manage our prescription drug benefits and when prescription formulary updates are made, Highmark will notify any employee/family member impacted by this change via US Mail prior to the required change.  

Starting January 1, 2025, the following formulary changes were implemented, and Highmark sent letters in fall 2024 to those impacted by this update. Please review each page below specific to the formulary change that may have impacted you.

Weight Loss Medication Formulary Change
Other 2025 Formulary Changes (including Continuous Glucose Monitoring)

Please discuss any medication questions with your doctor. For questions about your coverage, please call Highmark Member Service at 844-945-5509.  
 

Pharmacy

Beginning January 1, 2023, prescription coverage will be administered through Highmark’s partnership with Express Scripts. Specialty medications will be administered by Accredo.

Participating employees can continue to utilize University Health Services (UHS) for their pharmacy needs or utilize an in-network pharmacy to fill their prescriptions under Express Scripts/Accredo. For employees utilizing specialty medications, the Accredo Specialty Medication Guide will be helpful regarding the refill process or where to call for assistance.

Additional details regarding University Health Services Pharmacy are located through Penn State’s Office of Student Affairs.

All major chains, except Walgreens, are included in the Express Scripts pharmacy network. If your current pharmacy is participating with Express Scripts, you will simply need to present your new Highmark ID card, for your prescription to be processed correctly under your medical plan. You can verify your pharmacy by visiting the Highmark website and clicking on Find A Doctor Or Pharmacy using more detailed instructions below:

Locate an in-network Pharmacy

1. After clicking Find a Doctor or Pharmacy, click on Find A Pharmacy.
2. Next you will need to select Locate a National Network Pharmacy.
3. Enter Zip Code and click Search to locate an in-network pharmacy near you.

Find your prescription on the Formulary

1. After clicking Find a Doctor or Pharmacy, click on Find a Drug.
2. Next you will need to select National Select Formulary.
3. Search for your prescription drug name on the list.

HIGHMARK COPAY ARMOR

Lion Traditional Participants Only – select specialty medication.

For participants in the Lion Traditional plan, Highmark utilizes a voluntary copay assistance program, called Copay Armor, to help reduce the cost of select high-priced specialty medications.

Copay Armor, powered by PillarRx Consulting, helps to leverage manufacturer assistance dollars to lower your out-of-pocket specialty prescription costs. The team at PillarRx works with you through personalized service. No matter what, your out-of-pocket costs will always be the same or less than what you’re currently paying. Upon enrollment in the Lion Traditional medical plan, participants should expect to receive a welcome letter in the mail as well as a phone call from PillarRx regarding enrollment in the voluntary program for select specialty medication.

Advantages of the Copay Armor program:

• You’ll save money with manufacturer assistance — low to $0 out-of-pocket costs.
• Copay Armor works at any in-network specialty pharmacy.
• The PillarRx team is always there to assist you.
• There is no additional cost to enroll in Copay Armor.

Please contact the Highmark Concierge Team with any questions regarding the Copay Armor program.

OTHER COPAY ASSISTANCE PROGRAMS

There may be opportunities for you to pay lower out-of-pocket costs on select medications at retail pharmacies, including UHS. In many cases, your out-of-pocket costs will be the lowest through the drug plan. We encourage Penn State members to be educated consumers and if you are able to find a lower cost option to utilize that benefit to supplement the insurance provided through Highmark today. 

Option 1: Use a drug discount card.  Vendors such as GoodRx partner with retail pharmacies to offer lower prices for brand and generic drugs. There are many options available, which can be found via Google. Any pharmacy claims that use a drug discount card do NOT go through the prescription plan and therefore will NOT accumulate towards your deductible, if applicable, or out-of-pocket maximum. 

Option 2: Use a copay assistance program (i.e. a copay card) provided by the drug manufacturer for a Brand drug.  These dollars are separate funds allocated by the manufacturer to promote brand loyalty and can be used in addition to your prescription plan benefits.  The easiest place to find more information is by going to the website for your drug (use Google if needed).  Please note that only the amount that you actually pay will count towards your out-of-pocket maximum.

University Health Services (UHS) | 814-865-4847 | UHS Pharmacy Services for Employees

Highmark Concierge Team | 844-945-5509

Express Scripts Mail Order Form

UHS Mail Order Form

Faculty, Staff, and Postdoctoral Appointees

ACA Preventive Drug List ACA Preventive Drug List	0% coinsurance
Preventive Drug List Highmark PrevenRx Drug List
Generic	10% coinsurance
Preferred Brand Drugs	20% coinsurance
Non-Preferred Brand Drugs	40% coinsurance
All other non-ACA or non-Preventive Drugs
Retail (30-day supply)
Generic Drugs	50% coinsurance
Preferred Brand Drugs	50% coinsurance
Non-Preferred Brand Drugs	70% coinsurance
Mail Order (90-day supply)
Generic Drugs	20% coinsurance
Preferred Brand Drugs	20% coinsurance
Non-Preferred Brand Drugs	70% coinsurance
Specialty (Accredo)
Preferred Drugs	50% coinsurance, $50 Maximum
Non-Preferred Brand Drugs	70% coinsurance, $100 maximum
Out-of-Pocket Maximum	$2,000/$8,000

 

Technical Service

ACA Preventive Drug List ACA Preventive Drug List	0% coinsurance
Preventive Drug List Highmark PrevenRx Drug List
Generic	10% coinsurance
Preferred Brand Drugs	20% coinsurance
Non-Preferred Brand Drugs	40% coinsurance
All other non-ACA or non-Preventive Drugs
Retail (30-day supply)
Generic Drugs	50% coinsurance
Preferred Brand Drugs	50% coinsurance
Non-Preferred Brand Drugs	70% coinsurance
Mail Order (90-day supply)
Generic Drugs	20% coinsurance
Preferred Brand Drugs	20% coinsurance
Non-Preferred Brand Drugs	70% coinsurance
Specialty (Accredo)
Preferred Drugs	50% coinsurance, $50 Maximum
Non-Preferred Brand Drugs	70% coinsurance, $100 maximum
Out-of-Pocket Maximum	$1,000/$6,000

Lion Advantage HSA: Faculty, Staff, Postdoctoral Appointees, and Technical Service

Lion Advantage FLEX: Faculty, Staff, and Postdoctoral Appointees

ACA Preventive Drug List ACA Preventive Drug List	0% coinsurance
Preventive Drug List Highmark PrevenRx Drug List For preventive drugs under either Lion Advantage plan: Coinsurance only applies. The medication will not accumulate toward your deductible.
Generic	10% coinsurance
Preferred Brand	20% coinsurance
Non-Preferred Brand	40% coinsurance
All other non-ACA or non-Preventive Drugs
Retail (30-day supply)
Generic Drugs	10% coinsurance
Preferred Brand Drugs	20% coinsurance
Non-Preferred Brand Drugs	40% coinsurance
Mail Order (90-day supply)
Generic Drugs	10% coinsurance
Preferred Brand Drugs	20% coinsurance
Non-Preferred Brand Drugs	40% coinsurance
Specialty (Accredo)
Preferred Drugs	20% coinsurance, $65 Minimum
Non-Preferred Brand Drugs	40% coinsurance, $100 Minimum
Out-of-Pocket Maximum	Integrated with Medical

Highmark Copay Armor Video Tutorial