Highlights: Highmark Health Plans

In 2024, Highmark:

• Once again earned industry-leading Medicare Advantage Stars ratings, demonstrating its commitment to members' quality of care and overall health experience.
• Expanded its PA statewide presence by offering Medicare Advantage products in the southeastern PA market for the first time.
• Continued to expand its Affordable Care Act (ACA) membership, with more than 240,000 consumers choosing Highmark — an increase of more than 100,000 members over the past three years.
• Lowered the cost of prescription drugs, including by offering a lower-priced generic cancer medication to members that saved more than $6 million compared to the standard market price.

Highmark fully embedded a universal SDOH assessment into its care model to identify and address root causes impacting a member's health. Since 2019, the organization has conducted more than 1.9 million SDOH screenings. This proactive approach, coupled with the Highmark Community Support platform, connects individuals with thousands of free or reduced-cost community resources, ensuring access to vital food, housing, medical, and financial assistance.

This is one of the largest efforts of its type in the nation, earning Highmark recognition by the U.S. Department of Health and Human Services, the Journal of the American Medical Association, and from the White House Challenge to End Hunger and Build Healthy Communities.

It also fuels care innovation, like the Social Care Network consisting of nearly 40 Community-Based-Organizations in western PA, who all accept referrals from clinicians to maximize effectiveness of the care members receive. The network has connected nearly 1,000 members to social support services.

Highmark's commitment to address SDOH factors extends beyond individual interventions. The enterprise leverages data-driven insights to understand community-specific challenges and collaborates with local organizations to co-create innovative solutions. Successful program examples include the West Virginia Food for Mountaineers program and Thrive18.

Highmark members taking abiraterone acetate, which is used to treat prostate cancer, are saving an average of $90 per month in out-of-pocket expenses for the medication through Highmark's role with CivicaScript and a select specialty pharmacy. Highmark members across Pennsylvania, New York, Delaware, and West Virginia are benefiting from this lower-cost generic medication. Highmark members, group customers, and the health plan have collectively saved over $6 million since the lower-cost version of abiraterone acetate first became available in September 2023. These savings are being shared with members and customers and reinvested in improving their experience.

In 2020, Highmark teamed up with the Blue Cross Blue Shield Association¹ and other leading Blues health plans from across the U.S. to found CivicaScript, a nonprofit generic drug company focused on bringing quality and affordable outpatient generic medications to consumers nationwide.

"This oral oncology medication is the first drug available through CivicaScript, and it is only the beginning of our work on behalf of our members to lower costs and increase access to essential generic medications," said Corey DeLuca, vice president of clinical and specialty pharmacy services for Highmark Inc.

The portfolio of lower-cost medications available through CivicaScript will continue to expand, with a focus on generic outpatient drugs that treat specialty and other chronic health conditions such as cancer and diabetes.

"We have seen more essential generic outpatient medications become scarce or expensive in recent years, creating barriers to better health," DeLuca said. "These shortages and price spikes create additional stress and financial strain for consumers. When it became time to develop a national response, Highmark stepped up and has continued to play an important role in CivicaScript’s mission to lower costs and increase access for patients across the country."

CivicaScript is a subsidiary of Civica Rx, which was founded in 2018 by philanthropies and health systems from across the U.S. with the initial goal of stabilizing the supply and cost of generic drugs in hospital settings. Allegheny Health Network, a Highmark Health organization, was a founding member of Civica Rx's hospital-focused initiative.

¹ The Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.