The specialty pharmacy operated by Allentown, Pa.-based Lehigh Valley Health Network, under Philadelphia-based Jefferson Health, filed a lawsuit Nov. 10 against Highmark regarding the ability to dispense drugs.
The complaint, filed in a state court, alleged that Highmark is blocking LVHN’s pharmacy from dispensing some high-cost, self-administered specialty drugs to Highmark members, including LVHN patients. According to the lawsuit, LVHN’s pharmacy is a participating provider under a Sept. 25, 2023, contract, but Highmark routes some prescriptions to other pharmacies, including Highmark Health’s Allegheny Health Network Specialty Pharmacy.
In the contract, there is an “excluded” list of drugs that LVHN’s pharmacy does not handle for Highmark members, the complaint said. The list consists of only some infusion drugs, and Highmark can edit the list if it notifies the pharmacy in writing 30 days in advance.
LVHN alleged that, outside the contract, Highmark created a “closed specialty” list around summer 2024 that includes self-administered drugs. The lawsuit said Highmark did not inform the pharmacy until July 2025, after escalation.
The complaint alleged that those prescriptions are automatically sent to other pharmacies before a bidding process, despite LVHN’s pharmacy being listed as a participating provider. LVHN’s pharmacy argued that its tier designation could only change through an agreement amendment.
“Highmark is unfairly restricting access to specialty medications and steering patients to a competing pharmacy it owns,” Jefferson said in a statement shared with Becker’s Nov. 11. “These actions violate our current agreement, undermine care coordination and put corporate interests ahead of patients. We are taking action to hold Highmark accountable and protect patients’ access to the care team they know and trust.”
Jefferson and Highmark are currently entrenched in contract negotiations leading up to 2027. LVHN is asking the court to order Highmark to scrap the “closed specialty” drug list. LVHN said its pharmacy’s damages amount to millions of dollars.
“While we typically do not comment on pending litigation, Highmark stands behind the goals of its specialty drug management program, which is designed to give members timely access to specialty medications and high-quality pharmacy care, while helping make treatment more affordable,” a Highmark statement said. “We are reviewing the alleged claims raised by Jefferson Health and will respond through the appropriate legal process. Our priority remains doing what is right for our members and ensuring access to high-quality, affordable care.”
Jefferson also sued Independence Blue Cross, another insurer it is currently in negotiations with, earlier in 2026 over payment policy changes. Aetna is facing a lawsuit from the health system, as well.
