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PA Bulletin, Doc. No. 05-36

NOTICES

Highmark, Inc.; Adjustments to Injectable Drugs and Biological Allowances; Filing 200419; Rate Filing

[35 Pa.B. 86]

   On December 10, 2004, the Insurance Department (Department) received from Highmark, Inc. d/b/a Highmark Blue Shield and Highmark Blue Cross Blue Shield a filing requesting adjustments to the customary (Level II) UCR allowance and the PremierBlue preferred provider program fee schedule for injectable drugs and biologicals and the related chemotherapy and administrative services. The filing requests that injectable drugs and biologicals be reimbursed at 85% of the average wholesale price (AWP), except for newly FDA approved drugs and biologicals which will initially allow 95% of AWP and immunizations which will continue to be reimbursed at AWP plus 15%. The filing proposes to increase payment for chemotherapy and therapeutic related administration allowances. Highmark requests the approval without an immediate adjustment in rates for the programs affected by these codes. The company requests an effective date of March 7, 2005.

   Unless formal administrative action is taken prior to January 24, 2005, the subject filing may be deemed approved by operation of law.

   A copy of the filing is available on the Department's website at www.ins.state.pa.us. Under the Quick Links section, click on the link ''Rate Filings Published in the PA Bulletin.''

   Copies of the filing are also available for public inspection, by appointment, during normal working hours at the Department's regional office in Harrisburg.

M. DIANE KOKEN,   
Insurance Commissioner

[Pa.B. Doc. No. 05-36. Filed for public inspection December 30, 2004, 9:00 a.m.]


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