Highmark has found itself once again fighting a lawsuit, this time because it allegedly violated a contract with Duquesne University by improperly reimbursing contraceptives and medications that are in opposition of the university's Catholic mission.
Highmark began administering Duquesne's medical benefits program in April 2004, but wasn't supposed to cover certain medications and procedures, including contraceptive drugs and related procedures, the Pittsburgh Post-Gazette reports. Duquesne, which is a Catholic institution, will not cover abortions, contraceptives, or related medication and procedures, according to KDKA.
However, Duquesne is claiming that Highmark paid claims for contraceptives, as well as Botox. Highmark allegedly also approved payments for drugs that the university excluded from coverage for technical reasons, including immune globulin and Infliximab, that treat autoimmune disease such as HIV, reports the Pittsburgh Tribune-Review.
Duquesne says Highmark mishandled its prescription drug plan by using its own pharmacy benefits manager (PBM) instead of the one Duquesne specified in the contract. Although Highmark was supposed to send the prescription drug claims to Caremark PSC Health, it directly processed some of the drug claims and sent others to its PBM subsidiary Medmark, thereby denying the school its benefits allowed from Caremark.