Jefferson Health Sues Highmark Over Specialty Pharmacy Access
Lehigh Valley Health Network's specialty pharmacy, operated under Jefferson Health, filed suit against Highmark on Nov. 10 in state court, alleging the insurer is blocking its pharmacy from dispensing certain high-cost, self-administered specialty drugs to Highmark members. The complaint claims that despite a September 2023 contract naming LVHN's pharmacy as a participating provider, Highmark created a "closed specialty" drug list around summer 2024 that routes prescriptions to other pharmacies, including Highmark-owned Allegheny Health Network Specialty Pharmacy, before informing LVHN in July 2025. LVHN argues its tier designation can only be changed through a contract amendment and is asking the court to order Highmark to eliminate the closed list, citing millions of dollars in damages. Highmark says it stands behind its specialty drug management program and is reviewing the claims; Jefferson is separately in contract negotiations with Highmark ahead of 2027 and has also sued Independence Blue Cross and Aetna this year.