March 31, 2022
To: All Staff with Blue Shield Health Insurance Coverage
From: Andrew Giaquinto, School Business Manager
Re: Highmark – Acquisition of Blue Shield Effective July 1, 2022
Blue Shield has announced that they have been acquired by a larger, affiliated Blue Shield entity known as Highmark. The transition to the Highmark prescription drug platform is effective for our District beginning July 1, 2022. Given that both Blue Shield entities are using Express Scripts as their Pharmacy Benefit Managers (PBM’s), we expect that the transition will be fairly smooth.
What does Highmark’s acquisition of Blue Shield mean for members?
For most participants, the only impact from the acquisition will be the issuance of updated medical and/or prescription drug cards, identifying the name change from Blue Shield of Northeastern New York to Highmark, as well as new ID numbers and customer service phone numbers. The cards should begin arriving by First Class mail in June. Members can also view and print cards by registering for a personal account at highmark.com/blueshieldneny beginning July 1, 2022.
PBM’s have formularies that identify which drugs are available to participants, and at what co-payment amounts. The District is using the formulary that most closely matches the current formulary, to make this transition as seamless as possible.
Some members will see a reduction in their co-payment amount (i.e. from $40 per fill to $25 per fill). Members will not be notified of this positive change, but you will see the cheaper co-payment when you fill your prescription.
Some members may see an increase in their co-payment amount (i.e. from $25 per fill to $40 per fill). You will receive a letter from Highmark in May if you are affected by this. You may be able to maintain the same co-payment amount by switching to a different medication, which you should discuss with your physician. You might also be able to take advantage of the CanaRx program, which offers name-brand maintenance medications at a $0 co-payment amount.
A very small percentage of participants may receive a notice that their prescription requires Prior Authorizations from the PBM. In these situations, the participant’s physician will be notified of this by Highmark, and the physician will submit the required documentation on behalf of the patient. Highmark notes that physicians typically prescribe generic drugs first, and then try name-brand drugs until the patient attains the best medical result. Following the physician’s submission of this information, many patients will be able to stay on their current prescription. A dedicated high-level reviewer at Highmark will be available to help participants who experience any concerns with this review process.
Our Human Resource Specialist, Martha Moran, firstname.lastname@example.org, will be available to help you in the event you have any questions about the Highmark migration. Please do not hesitate to reach out should you need any assistance.