Pittsburgh-based insurer Highmark is further expanding its drug offerings through CivicaScript and leaning on biosimilars as pharmaceutical costs continue to rise for many.
Highmark is a founding member of the drug company, which manufactures lower-cost alternatives to high-cost generic products. CivicaScript is a sister to Civica Rx, a drugmaker cofounded by health systems that makes key products for care facilities, which are often in short supply.
The insurer first made abiraterone acetate, a drug for treating prostate cancer, available through CivicaScript in 2023, and found that members are saving $90 each month on average thanks to this partnership and its relationship with specialty pharmacies.
Highmark said that more than 300 members are benefiting from the savings—across both individual and group customers, the plan has collectively saved $8 million.
And as of September 2025, Highmark is now offering four additional CivicaScript products: dimethyl fumarate and dalfampridine, which are both used to treat multiple sclerosis; droxidopa, which is used for neurogenic orthostatic hypotension; and capecitabine, a cancer drug.
Corey DeLuca, vice president of clinical and specialty pharmacy services at Highmark, told Fierce Healthcare that, for example, abiraterone acetate was a generic drug that still carried a price tag in the thousands of dollars. And that cost is felt by both plan sponsors and patients.
“We did see the cost of this medication come down dramatically for a lot of patients, just because the total cost came down, and thus their portion of their cost share came down as well,” DeLuca said.
“It’s still early with the next four drugs,” she said. “But we’re also seeing that it’s bringing down members’ cost share, especially in the health plans that a lot of our customers choose that may have a deductible component, or a patient has to pay a percent coinsurance component as well.”
DeLuca said that CivicaScript has to date largely focused on drugs that benefit from a partnership with a specialty pharmacy and are less dependent on retail or community pharmacies. That said, the team is actively looking at drugs in the latter category, and strategizing around how to best partner with retail pharmacies on access.
Identifying specialty generics that are cost-prohibitive and working with specialty pharmacies provided an easier on-ramp for distribution than drugs dispensed at retail pharmacies.
“If you partner with one or two retail pharmacies, you’re only able to maybe get a portion of your membership the access to that drug,” she said.
In addition to the insurer’s involvement with CivicaScript, DeLuca said the team at Highmark is focused on ways to boost access and uptake of biosimilars. Part of that effort has included a partnership with Free Market Health, a tech company that matches specialty medication referrals and pharmacies based on cost and value.
Highmark has found that first-time users of specialty drugs are more likely to begin therapy quickly and stick with it when they’re in the program.
DeLuca said that the rollout of new biosimilars for Humira and Stelara, two of the most widely used branded specialty products, has opened the door for more patients to shift to a biosimilar option. New biosimilars are also coming to market more quickly, making access easier, she said.
“The tides are starting to change here, in the spirit of access and affordability to these therapies,” she said.
As it adjusts formularies to drive uptake of biosimilars, DeLuca said that Highmark is working closely with its provider network to ensure that they understand the reason for the changes and the assistance that’s available for members.
They’re also easing prior authorization and other barriers to accessing these drugs, DeLuca said.
“We’ve done all those things together to really help make this as seamless a transition as possible,” she said.
Publisher: Source link
