Pharmacy Tools

Free Market Health (FMH) is a healthcare technology company that orchestrates and optimizes the specialty drug fulfillment process. In April of 2021, Highmark Wholecare collaborated with FMH to launch an 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 collaborating 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?

• Upon an approved prior authorization for select specialty drugs, FMH receives the referral for management.
• FMH orchestrates Highmark Wholecare’s program configuration and evaluates the referral based on drug, disease, member, and plan attributes.
• The referral, inclusive of care accountabilities and incentives, is matched to an in-network specialty pharmacy best-suited to service the referral.
• 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, and prescribers should continue to submit prior authorizations as usual.

Because any in-network specialty pharmacy may service Highmark Wholecare members, prescribers and their patients may notice new specialty pharmacies dispensing their medication(s). The specialty pharmacy authorized by Highmark Wholecare to service a specialty referral will coordinate with the prescriber office to obtain the prescription. Highmark Wholecare 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.

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.

Free Market Health, a separate healthcare technology company, provides end-to-end specialty drug process optimization for Highmark Wholecare members.