Medication Information

Free Market Health (FMH) is a health care technology company that orchestrates and optimizes the specialty drug fulfillment process. Highmark Health Options works with FMH's innovative specialty pharmacy program for select specialty medications. The program facilitates a match process that gets a specialty prescription to the in-network specialty pharmacy best-suited to service that member.

Specialty medications included in the Free Market Health program are indicated as Specialty Pharmacy Group A (or SPA) on the Specialty Drug List.

Why are we working with Free Market Health?

• To increase process efficiency, improve care quality, and decrease the time it takes for members to receive their medications.
• To offer transparent and fair access to authorized referrals to our specialty pharmacy network and reward high-quality care.
• To leverage dynamic drug rates and ensure specialty drugs remain affordable for our members.

How does the program work?

1. Upon an approved prior authorization for select specialty drugs, FMH receives the referral for management. 
   
2. FMH orchestrates Highmark Health Options program configuration and evaluates the referral based on drug, disease, member, and plan attributes.
3. The referral, inclusive of care accountabilities and incentives, is matched to an in-network specialty pharmacy best-suited to service the referral.
4. The assigned specialty pharmacy will reach out to the prescriber to obtain the prescription and onboard the member to initiate service.

How does this impact prescribers?

The prior auth process is not changing. Prescribers should continue to submit prior auths as usual.

Because any in-network specialty pharmacy may service Highmark Health Options members, prescribers and their patients may notice new specialty pharmacies dispensing their medication(s). The specialty pharmacy authorized by Highmark Health Options to service a specialty referral will coordinate with the prescriber office to obtain the prescription. Highmark Health Options works closely with network pharmacies to maintain strict controls for quality. Member preference for a specialty pharmacy will be honored if the pharmacy remains in network and can supply the specialty medication.

How does this impact members?

The specialty drug process under FMH is managed and streamlined to decrease the time it takes for members to receive their medications, monitor first fills, and reduce medication abandonment for members in need of and authorized for a specialty drug. Members are also serviced by a specialty pharmacy capable and accountable to meet their needs with focused care management that improves the patient experience. Member preference for a specialty pharmacy will be honored if the pharmacy remains in network and can supply the specialty medication.

Have questions?

Prescribers or specialty pharmacies wanting more information on the Free Market Health program or in need of assistance can contact the FMH team at 877-787-0520 or visit the Free Market Health website.

StellarRx provides on-site stocking and inventory management of asthma (i.e., inhalers, nebulizers, and supplies) and contraceptive (i.e., birth control pills, IUDs and subdermal implants) medications in a secure XpeDose™ cabinet, ready for use in a single visit. This prescription dispensing system is available to all Highmark Health Options providers free of charge. Learn more about StellarRX by visiting their website or reviewing the following resources:

• XpeDose for Asthma
• Asthma Forumulary
• XpeDose for Family Planning
• Family Planning Formulary