Traditional MedicareReimbursementMedium impact
Pricing Calculated to Five Decimal Points for Certain Drug Codes
Highmark·PA, NY, DE, WV · Pharmacy·Pharmacy
Effective date
Jul 17, 2026
We identified it
Jun 26, 2026
Summary
Effective July 17, 2026, Highmark will calculate pharmacy drug code pricing to five decimal points for specific drug codes to comply with CMS regulations and ensure accurate provider allowances. This precision pricing change affects how reimbursement is calculated for covered pharmacy services.
Action Required
By July 17, 2026: Billing team must coordinate with IT to verify that billing software and claims submission systems can process and accept five-decimal pricing calculations for pharmacy drug codes. Test claims submissions with Highmark to confirm systems properly handle five-decimal precision in reimbursement calculations. Notify providers that reimbursement amounts for certain pharmacy codes may display with five decimal points. Failure to support five-decimal pricing may result in claim processing errors or rejections.