Who is the PBM for Blue Cross Blue Shield of California?
Understanding the PBM Landscape
When it comes to healthcare in California, Blue Cross Blue Shield (BCBS) is a well-known name. But what does PBM stand for, and why is it important?
PBM stands for Pharmacy Benefit Manager. These companies act as intermediaries between healthcare providers, pharmaceutical manufacturers, and insurance companies. They negotiate drug prices, manage prescription drug benefits, and oversee mail-order pharmacies.
So, who is the PBM for BCBS of California?
The PBM Partnership
As of 2023, BCBS of California has partnered with Express Scripts as its primary PBM. This means that Express Scripts handles the prescription drug benefits for many BCBS members in California.
Why Express Scripts?
Express Scripts is a leading PBM in the United States, known for its:
- National Network: Express Scripts has a vast network of pharmacies across the country, making it convenient for BCBS members to fill their prescriptions.
- Drug Pricing Negotiations: The company negotiates drug prices with pharmaceutical manufacturers on behalf of its clients, including BCBS. This can help to keep prescription costs down.
- Clinical Programs: Express Scripts offers various clinical programs to help members manage their chronic conditions and improve their overall health.
Navigating Your Prescription Benefits
If you're a BCBS member in California, understanding your prescription drug benefits is important. Here are some key things to know:
- Formulary: BCBS maintains a list of approved drugs called a formulary. Your coverage may be limited to drugs on this list.
- Tiers: Prescription drugs are often categorized into tiers based on cost. You may pay different co-payments or deductibles depending on the tier of the drug.
- Mail-Order Pharmacy: Express Scripts offers a mail-order pharmacy option for certain medications. This can sometimes be more convenient and affordable than filling prescriptions at a retail pharmacy.
FAQs
How to find a participating pharmacy in the Express Scripts network?
You can use the Express Scripts pharmacy locator tool to find pharmacies near you that accept their prescriptions.
How to check my prescription drug coverage?
You can log in to your BCBS member portal to view your prescription drug benefits and coverage information.
How to get a prior authorization for a non-formulary medication?
If you need a non-formulary medication, you may need to obtain a prior authorization from your doctor and BCBS.
How to manage my chronic conditions through Express Scripts programs?
Express Scripts offers various programs to help members with chronic conditions, such as diabetes and asthma. You can contact your doctor or BCBS for more information.
How to switch to the Express Scripts mail-order pharmacy?
You can contact Express Scripts or your BCBS representative to enroll in their mail-order pharmacy program.