Changes to extended health

Pacific Blue Cross (PBC) has made changes to the Reasonable and Customary Limits for the following two provisions, effective January 1, 2015:

1) Diabetic Test Strips Reasonable and Customary limit

The reasonable and customary amount has been determined as a maximum of 3000 test strips per year. PBC intends to communicate with all impacted members directly in advance to ensure they are advised prior to the change taking place. If a confirmed medical necessity is proven, additional test strips will be allowed.

2) High cost drug markup reasonable and customary level

Pacific Blue Cross (PBC) has implemented a reasonable and customary markup level for high cost drugs where applicable patient assistance programs exist. In making this change, PBC is ensuring all other funding resources are used prior to the extended health plan. If pharmacy charges exceed the reasonable and customary rate, rather than the pharmacy billing the patient, the expectation is that the pharmacy will either be required to absorb the difference or obtain funding from the patient assistance program. PBC does not expect members to be out of pocket as a result.

View or print the detailed information from Pacific Blue Cross

Learn more about Reasonable and Customary Limits