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Pharmacy Management

For years, members have relied on Blue Cross-of California (BCC) for coverage of safe and effective prescription medications that encourage good health while providing an affordable benefit.Blue Cross of California offers health improvement programs (disease management programs) to our members with asthma, diabetes, congestive heart failure (CHF) and/or cardiovascular disease (CVD), cancer and musculoskeletal conditions (rheumatoid arthritis, osteoarthritis, and low back pain).

Our health improvement programs (HIPs) provide an innovative, interdisciplinary approach to helping members manage their chronic conditions. Our Baby Connection program is also available to prenatal members. All of our HIPs and Baby Connection are coordinated and administered completely in-house.

Our programs involve an individualized approach and utilize one-on-one communication with each participant to assess individual needs. Members work with a team of health care professionals - led by a registered nurse acting as a "health coach" and including their personal physicians - to achieve health and lifestyle goals. Participation in our HIPs is always voluntary.

Prescription drug benefits are administered through Well Point Pharmacy Management (WPM), our wholly owned Pharmacy Benefits Management (PBM) company. BCC prescription drug benefits promote greater flexibility to manage overall health care cost. The ability to review both medical and pharmacy claims allows for integrated clinical programs that help reduce rising prescription drug costs and facilitate comprehensive management programs.

Prescription drug benefits, often tied to a preferred drug list, provide our members with safe and cost-effective treatment options, while ensuring access to non-preferred, yet medically necessary medications. Our expansive selections of prescription drug plans provide choice, versatility and affordability. Prescription drug benefits and clinical programs vary widely between benefit designs.

This section reflects general administration and is intended for informational purposes only. It is not a guarantee of coverage, as some policies do not provide pharmacy benefits. Benefits are implemented according to the provisions outlined in the member's Evidence of Coverage (EOC).