Posted in #unitedhealthcare, Payers and CPT reinbursement, Pharmacy (Various Insurance Payers)

UHC Medicaid: Idaho: diabetic DME coverage change-benefit

Starting for DOS 4/1/26 and thereafter the following codes will be covered through the patient pharmacy benefit and no longer will be covered under patient medical benefit.

For DOS 1/1/26 through 3/1/26- providers can still bill either through medical benefit or pharmacy benefit.


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Posted in #reimbursement, NY Providers, Payer Updates, Payers and CPT reinbursement, Pharmacy (Various Insurance Payers), Training

Healthfirst Pharmacy Update Contrast agent reimbursement

The following information applies to the members in the following plans: Managed Medicaid Plans and Personal Wellness Plans (HARP)


Back in 2023, NYS DOH announced that there will be a change to the pharmacy benefits for MMC, HARP members- the pharmacy benefits will be covered but NYRx.

This change was finally implemented in April 2025.


To align closer with this policy Healthfist will NO LONGER reimburse separately for the the following contrast agents used in radiological testing.


Coding: the following codes are affected:

Images via Healthfirst website

NYS Medicaid Pharmacy website: information here


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Posted in #reimbursement, BCBS (Various States), BCBS Empire NY, NY Providers, Pharmacy (Various Insurance Payers)

BcBS HighMark NY: coverage for COVID-19 vaccine

According to Highmark BCBS- the COVID-19 vaccine will be covered with out any pocket costs through 2025-2026.

This currently only applies to Managed Medicaid, Child Health Plus, Essential and HARP plan types.

The vaccine will still be part of standard preventive care benefits, COVID‑19 vaccines are covered for all members older than 6 months of age.

Members are encouraged to contact their primary care or pharmacy for vaccine availability.


Highmark will partner with Wellpoint companies to administer this benefit.

As per Highmark-Wellpoint Insurance Services, an independent company, administers utilization management services for Highmark Blue Cross Blue Shield’s managed Medicaid.
Wellpoint Partnership Plan, LLC provides management services for Highmark Blue Cross Blue Shield’s managed Medicaid.


Certain sef-insured plans have special vaccine coverage and should check their benefits coverage for more info.


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