Prescription Coverage - PPO Blue Plan

The Pharmacy Benefit Manager for Highmark Blue Shield is Express Scripts.

To view the drug formulary, a list of participating pharmacies, and price comparisons for 31-day and 90-day supplies of generic and brand-name medications, or to order refills of prescription medications, please see the Prescriptions tab on the Highmark website.

Highmark Comprehensive Drug Formulary

For questions regarding prescription benefits or claims, please contact Highmark Blue Shield at 800-914-4384.

PPO Blue Prescription Coverage - Faculty & Staff

PPO Blue Prescription Coverage - Teamsters

Retail Prescriptions

  • Drugs that are purchased at a local participating pharmacy
  • Maximum supply available is 31 days
  • Member pays 50% of the cost at the counter
  • Medication that is not on the formulary will require member to pay 70% of the cost

Generally, the retail method is used for short-term prescriptions, such as an antibiotic. While maintenance drugs can be purchased on a retail basis, the maintenance prescription drug plan is more cost effective.  

Mail Order Maintenance Prescriptions

  • Drugs that are prescribed for the long-term treatment of a condition
  • Maximum supply available is 90 days
  • Member pays 20% of the cost
  • Medication that is not on the formulary will require member to pay 70% of the cost

Maintenance drugs are available from Express Scripts by Mail and from the University Health Services (UHS) Pharmacy. Refills may be ordered online and by phone.

Drugs purchased through Express Scripts will be delivered to the member's home address. Drugs purchased from University Health Services Pharmacy can be delivered by campus mail at no cost or by U.S. Mail to the member's home for a $3.00 fee. 

Specialty Medications

Specialty medications are typically self-administered indictables, biological agents, biotechnology medications and other prescriptions that are not available at most pharmacies.

  • Walgreens Specialty Pharmacy is the exclusive provider for certain specialty medications
  • Dispensed in one-month supplies
  • Maximum cost $50/month for formulary drugs and $100/month for non-formulary drugs
  • Walgreens Specialty Medications Formulary

Additional Resources

For questions regarding prescription benefits or claims, please contact Highmark Blue Shield at 800-914-4384.