Highmark Essential Plan benefits

• Primary care provider (PCP) visits
• Immunizations and wellness visits
• Specialist visits
• Urgent care
• Emergency care
• Lab and X-ray services
• Pregnancy services
• Family planning
• Hospital care
• Physical therapy
• Behavioral health care

Check your Subscriber Contract for a full list of benefits in your plan. Your plan may have copays for covered services.

Find a Doctor 

If your plan includes dental services, you can get:

• Teeth cleaning twice a year
• Oral exams
• X-rays
• Extractions
• Fillings
• Emergency care
• Dentures (removable or partial)
• Orthodontics

Check your Subscriber Contract for a full list of benefits in your plan. Your plan may have copays for covered services.

Dental benefits are provided through Liberty Dental. To find or change your dentist, call Liberty Dental at 833-276-0847 (TTY 711), or visit their website.

Go to Liberty Dental 

If your plan includes vision services, you can get:

• One eye exam each year
• Prescription glasses or contact lenses each year

Check your Subscriber Contract for a full list of benefits in your plan. Your plan may have copays for covered services.

Find a vision provider 

Your benefits include a wide range of prescription and over-the-counter (OTC) drugs. We work with CarelonRx to provide these benefits.

Check your Subscriber Contract for a full list of benefits in your plan. Your plan may have copays for covered prescriptions.

Visit the pharmacy page to find a pharmacy near you and check if your medicine is on the Preferred Drug List (PDL).

Find a pharmacy 

Highmark Blue Cross Blue Shield has a preferred drug list (PDL), also called a formulary. It includes all medicines covered by the Essential Plan. Many of the drugs listed on the PDL do not need preapproval. Drugs not listed on the PDL always require preapproval. This means your doctor must get approval from us before they can write a prescription for the drug. Go to the preapprovals section below for more information. The PDL can change at any time. Please check back for updates.

When there is a generic drug available, it will be covered. Generic drugs are equal to brand-name drugs and approved by the Food and Drug Administration. Requests for brand-name drugs when generics are available will need preapproval. You can email us to ask for an exception.

 Highmark Essential Plan Preferred Drug List (English)

 Highmark Essential Plan Preferred Drug List (Spanish)

If you have any questions about your pharmacy benefit, call Pharmacy Member Services at 833-232-1713 (TTY 711) 24 hours a day, seven days a week.

Search for brand-name and generic drugs that are on your medication list. You can search for your drug by:

• Typing the name (at least first three letters) of the drug in the search box
• Using the A-Z list to search by the first letter of your drug
• Clicking on therapeutic class of the drug

 Essential Plan Searchable Formulary

You can look in your new member enrollment package for a list of pharmacies in our plan. Or you can search our list of plan drugstores online. You can also call Pharmacy Member Services at 1-833-232-1713 (TTY 711) 24 hours a day, seven days a week or ask your local pharmacy for help.

We cover many OTC products, including pain relievers, antacids, contraceptives and some vitamins. All OTC products require a written prescription from your doctor and can be filled at any drugstore in our plan.

Your doctor can call our Pharmacy department at 866-231-0847 (TTY 711).

We have pharmacies in our plan in all 50 states. If you need a refill while on vacation, ask your doctor for a new prescription to take with you. You can also ask your doctor to fax it to the closest drugstore in our plan where you’ll be visiting.

If your medicines are lost or stolen, you should contact your doctor. Ask your doctor to authorize the pharmacy to refill your prescription early. The pharmacy may have to contact us for preapproval. Replacement of lost or stolen medicines will be reviewed on a case-by-case basis.

If you had to pay for a medicine, you may submit a request for reimbursement. You’ll need to mail a completed reimbursement request form along with any receipts to:

Claims Department

P.O. Box 52065

Phoenix, AZ 85072-2065

Enteral nutrition, diapers and durable medical equipment (DME) can be obtained through your (DME) benefit. You can get some medical supplies from your local pharmacy, like bandages, insulin syringes and glucose test strips.