Lehigh Valley Sues Highmark Over Specialty Drug Access

Lehigh Valley Health Network, the Allentown, Pa.-based system now under Philadelphia-based Jefferson Health, filed suit against Highmark on Nov. 10 in Pennsylvania state court, according to Becker's Hospital Review. The complaint alleges Highmark is blocking LVHN's specialty pharmacy from dispensing some high-cost, self-administered specialty drugs to Highmark members, including patients LVHN already treats.

The fight reflects a broader tug-of-war over specialty drugs, which carry high margins and account for a growing share of total drug spending. Payers and their pharmacy benefit managers increasingly route these prescriptions through their own in-network or affiliated pharmacies, a practice hospital systems argue cuts them out of revenue and disrupts care for patients who want their medications filled where they are treated.

For health systems that have invested heavily in building specialty pharmacy operations, network access is the whole game. If insurers can steer prescriptions elsewhere, those investments lose value. The case will test how much control payers hold over where members fill specialty drugs.