CurrentHighmark Blueshield NenyPolicy N/A

Free Market Health Drug List

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A consolidated list of drugs included in the Free Market Health program, separated by medical-benefit (HCPCS/J-codes and others) and pharmacy-benefit entries; affects providers, pharmacies, and members covered by Highmark Blueshield Neny enrolled in the Free Market Health program.

Policy Summary

PayerHighmark Blueshield Neny

PolicyFree Market Health Drug List

Policy CodePolicy N/A

Change TypeNo material change

Effective DateApr 15, 2026

Last ReviewApr 15, 2026

Next Review DateN/A

Key ActionUse the enumerated medical and pharmacy benefit drug lists (with effective dates) to determine program inclusion for members and claims.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

≈200+drugs and biologics listed

Medical & Pharmacybenefit types

HCPCS/J-codes presentcoding present

04/15/2026most recent update

Coverage — List-only Indications

List-only coverage indication

This part of the document provides an enumerated list of drugs included in the Free Market Health program; no utilization management criteria (e.g., prior authorization, step therapy) or exclusions are specified within these chunks.

Drugs enumerated by benefit type (medical and pharmacy) with effective dates provided; no clinical coverage rules included in these chunks.

List-only entries

This section is a roster of pharmacy-benefit drugs with associated effective dates; no explicit coverage criteria or utilization management rules are included in these chunks.

Pharmacy benefit drug entries are listed as drug name followed by an 'Effective Date' (e.g., 'POMALIDOMIDE, Pharmacy Benefit Drug List .Effective Date = 04/15/2026').

Entries serve as an inclusion roster only; the document does not state prior authorization, step therapy, quantity limits, or exclusion rules in these chunks.

Coding / Identifiers

Sample medical/HCPCS codes listedHCPCS

J3262	Actemra IV (medical benefit entry)
J0800	Acthar (medical benefit entry)
Q5150	Ahzantive (medical benefit entry)
J1931	Aldurazyme (medical benefit entry)

Sample pharmacy drug name entriesNDC

ABIRATERONE ACETATE	Pharmacy benefit drug list entry
ACTEMRA	Pharmacy benefit drug list entry
ADALIMUMAB	Pharmacy benefit drug list entry
BIMZELX	Pharmacy benefit drug list entry

NDC/Coding not providedNDC

Effective date presence

Presence of effective dateEach listed drug entry includes an 'Effective Date' indicating when the product was added or its status became effective.

Date range noted in entriesEffective dates in the document span multiple years (examples include 12/01/2021, 01/01/2022, 04/15/2026).

Applies to both benefit listsEffective dates are shown for pharmacy-benefit entries and medical-benefit coded entries alike.

Used for versioning and program inclusionThe effective date denotes when the drug became part of the Free Market Health Drug List for benefit administration.

Provider / Pharmacy Actions and Notices

Note

Reference the Free Market Health Drug List to determine benefit assignment

The Free Market Health Drug List enumerates all drugs included in the program and is split by benefit type (medical benefit and pharmacy benefit); providers must reference this list to determine whether a product is covered under the medical or pharmacy benefit. The list is maintained with an update date (Updated 04/15/2026) and should be used to verify benefit assignment when submitting claims or coordinating where the product will be obtained and billed.

List is split by medical benefit and pharmacy benefit (see header).
Updated 04/15/2026 — use the current list date to confirm status.

Documentation Required

Use pharmacy-benefit drug entries and Effective Dates when verifying pharmacy coverage

The pharmacy-benefit entries are listed as individual drug names with associated Effective Date values; when billing or dispensing, providers and pharmacies must use the drug name and its Effective Date from this list to confirm inclusion on the pharmacy benefit.

Example entries from the pharmacy list include ORGOVYX (Effective Date = 11/15/2022), ORKAMBI (04/18/2022), OTEZLA (11/15/2022), and others in the roster.
Several entries show recent Effective Dates (e.g., PHEBURANE 04/15/2026, POMALIDOMIDE 04/15/2026) — confirm the effective date shown when determining coverage.

Definitions and List Types

Medical Benefit Drug List

DefinitionMedical Benefit Drug List: entries are displayed with HCPCS/J-codes or other procedure/product codes and include an 'Effective Date'.

Code examplesSample entries use codes such as J3262 (Actemra IV), J0800 (Acthar), Q5150 (Ahzantive), and 90378 (Synagis) as medical-benefit identifiers.

PurposeUsed to indicate drugs administered/paid under the medical benefit and to record when that status became effective.

No utilization management in listThe listed medical-benefit entries in the document are rostered with codes and effective dates; explicit authorization rules are not present in these chunks.

Pharmacy Benefit Drug List

DefinitionPharmacy Benefit Drug List: product name entries (sometimes with formulation or device descriptor) accompanied by an 'Effective Date'.

Entry styleEntries appear as drug names (e.g., ABIRATERONE ACETATE, ACTEMRA, ADALIMUMAB) with an associated effective date for benefit inclusion.

ScopeIndicates products to be dispensed and adjudicated through the pharmacy benefit within the Free Market Health program.

Multiple formulations notedSome entries include formulation or device qualifiers (for example, PEN or AUTOINJECTOR) alongside the drug name and effective date.

Pharmacy Benefit Drug List entry

Entry formatPharmacy Benefit Drug List entry: a named drug followed by 'Effective Date = MM/DD/YYYY' indicating when the drug was added or became effective.

ExamplesExamples from the list include ORGOVYX .Effective Date = 04/18/2022; PIQRAY .Effective Date = 12/01/2021; POMALIDOMIDE .Effective Date = 04/15/2026.

ConsistencyEntries consistently pair the product name and an explicit effective date across the pharmacy-benefit roster.

Used for benefit administrationThe 'Effective Date' signals the date from which the pharmacy benefit status applies for claims processing.

Policy Summary

PayerHighmark Blueshield Neny

PolicyFree Market Health Drug List

Policy CodePolicy N/A

Change TypeNo material change

Effective DateApr 15, 2026

Last ReviewApr 15, 2026

Next Review DateN/A

Key ActionUse the enumerated medical and pharmacy benefit drug lists (with effective dates) to determine program inclusion for members and claims.

SourceLink

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Free Market Health Drug List

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Sign up for all Highmark Blueshield Neny policy alerts

Know when Highmark Blueshield Neny releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Coverage — List-only Indications

List-only coverage indication

Drugs enumerated by benefit type (medical and pharmacy) with effective dates provided; no clinical coverage rules included in these chunks.

List-only entries

This section is a roster of pharmacy-benefit drugs with associated effective dates; no explicit coverage criteria or utilization management rules are included in these chunks.

Pharmacy benefit drug entries are listed as drug name followed by an 'Effective Date' (e.g., 'POMALIDOMIDE, Pharmacy Benefit Drug List .Effective Date = 04/15/2026').

Entries serve as an inclusion roster only; the document does not state prior authorization, step therapy, quantity limits, or exclusion rules in these chunks.

Coding / Identifiers

Sample medical/HCPCS codes listedHCPCS

J3262	Actemra IV (medical benefit entry)
J0800	Acthar (medical benefit entry)
Q5150	Ahzantive (medical benefit entry)
J1931	Aldurazyme (medical benefit entry)

Sample pharmacy drug name entriesNDC

ABIRATERONE ACETATE	Pharmacy benefit drug list entry
ACTEMRA	Pharmacy benefit drug list entry
ADALIMUMAB	Pharmacy benefit drug list entry
BIMZELX	Pharmacy benefit drug list entry

NDC/Coding not providedNDC

Effective date presence

Presence of effective dateEach listed drug entry includes an 'Effective Date' indicating when the product was added or its status became effective.

Date range noted in entriesEffective dates in the document span multiple years (examples include 12/01/2021, 01/01/2022, 04/15/2026).

Applies to both benefit listsEffective dates are shown for pharmacy-benefit entries and medical-benefit coded entries alike.

Used for versioning and program inclusionThe effective date denotes when the drug became part of the Free Market Health Drug List for benefit administration.

Provider / Pharmacy Actions and Notices

Note

Reference the Free Market Health Drug List to determine benefit assignment

List is split by medical benefit and pharmacy benefit (see header).
Updated 04/15/2026 — use the current list date to confirm status.

Documentation Required

Use pharmacy-benefit drug entries and Effective Dates when verifying pharmacy coverage

Example entries from the pharmacy list include ORGOVYX (Effective Date = 11/15/2022), ORKAMBI (04/18/2022), OTEZLA (11/15/2022), and others in the roster.
Several entries show recent Effective Dates (e.g., PHEBURANE 04/15/2026, POMALIDOMIDE 04/15/2026) — confirm the effective date shown when determining coverage.

Definitions and List Types

Medical Benefit Drug List

DefinitionMedical Benefit Drug List: entries are displayed with HCPCS/J-codes or other procedure/product codes and include an 'Effective Date'.

Code examplesSample entries use codes such as J3262 (Actemra IV), J0800 (Acthar), Q5150 (Ahzantive), and 90378 (Synagis) as medical-benefit identifiers.

PurposeUsed to indicate drugs administered/paid under the medical benefit and to record when that status became effective.

No utilization management in listThe listed medical-benefit entries in the document are rostered with codes and effective dates; explicit authorization rules are not present in these chunks.

Pharmacy Benefit Drug List

DefinitionPharmacy Benefit Drug List: product name entries (sometimes with formulation or device descriptor) accompanied by an 'Effective Date'.

Entry styleEntries appear as drug names (e.g., ABIRATERONE ACETATE, ACTEMRA, ADALIMUMAB) with an associated effective date for benefit inclusion.

ScopeIndicates products to be dispensed and adjudicated through the pharmacy benefit within the Free Market Health program.

Multiple formulations notedSome entries include formulation or device qualifiers (for example, PEN or AUTOINJECTOR) alongside the drug name and effective date.

Pharmacy Benefit Drug List entry

Entry formatPharmacy Benefit Drug List entry: a named drug followed by 'Effective Date = MM/DD/YYYY' indicating when the drug was added or became effective.

ExamplesExamples from the list include ORGOVYX .Effective Date = 04/18/2022; PIQRAY .Effective Date = 12/01/2021; POMALIDOMIDE .Effective Date = 04/15/2026.

ConsistencyEntries consistently pair the product name and an explicit effective date across the pharmacy-benefit roster.

Used for benefit administrationThe 'Effective Date' signals the date from which the pharmacy benefit status applies for claims processing.