The Blue Cross and Blue Shield Service Benefit Plan has a special program to promote patient safety and monitor healthcare quality. The Patient Safety and Quality Monitoring (PSQM) program features a set of closely aligned programs that are designed to promote the safe and appropriate use of medications. Examples of what these programs do include:

Protecting Your Safety

When you have a prescription filled through a Network pharmacy (including Preferred Internet pharmacies), your prescription is automatically checked for potential problems related to:

• Interactions with other medicines you are taking
• Medicines that are inappropriate due to a disease or medical condition
• Medicines that are inappropriate based on age
• Unusually high or low medicine dosage
• Medicine duplication or excessive use
• Refills that are requested too soon

This service uses information stored from your previous prescriptions dispensed from the Pharmacy program. If any of these potential problems arise, the pharmacist may consult with you and your doctor to resolve any questions about the prescription before dispensing the medicine.

We encourage Standard Option members who use the Mail Service Prescription Drug program to complete a Health Assessment Questionnaire to indicate medicine allergies, health conditions, chronic diseases or sensitivity to any medicine. To obtain a Health Assessment Questionnaire, contact the Mail Service Prescription Drug program at 1.800.262.7890.

Specialty Pharmacy Services

Patients on specialty medications used to treat chronic conditions require enhanced care and monitoring of their drugs to make sure they are safe and effective. Administered by injection or through intravenous infusion, they usually require special handling or refrigeration. Accredo, a Medco company, manages the treatment and delivery of these complex medications for our Service Benefit Plan Members.

To learn more about Specialty Pharmacy Services, the Mail Service Pharmacy users can contact Accredo at 1.800.501.7260. Accredo provides 24/7 access to knowledgeable professionals who know about the various medications used to treat chronic conditions. Retail Pharmacy users can contact Caremark at 1-800-624-5060.

Prior Approval

For certain prescription medicines, the Service Benefit Plan Pharmacy Program must determine whether the medicine is related to a service or condition that is covered under the Service Benefit Plan before benefits can be approved. We also evaluate whether the medicine is prescribed in accordance with generally accepted medical practices.

The Prior Approval Program ensures that Members have access to appropriate quantities of medicine either by requiring Prior Approval of a medicine before benefits can be paid or making available a set amount of medicine within a specific timeframe.

The following list includes medicines which currently require Prior Approval.

Drugs Requiring Prior Approval

Aciphex*	Neulasta
Acthar Gel	Neupogen
Actiq	Nexium*
Ambien*	Nuvigil
Amerge*	Orencia
Amphetamines	Pegasys
Anorexiants	PEG-Intron
Aranesp	Prevacid Napra PAC
Atralin	Prevacid*
Avastin	Prevpac*
Avonex	Procrit
Betaseron	Protonix*
Botox	Provigil
Celebrex	Pulmozyme
Ceprotin	Rebetol
Copaxone	Rebetron
Copegus	Rebif
Dalmane*	Relenza*
Differin	Relpax*
Dovonex	Renova 0.05%
Epiduo Gel	Restoril*
Epogen	Retin-A
Estazolam*	Revatio
Exjade	Serostim
Fentora	Smoking Cessation Products*
Frova*	Soliris
Growth Hormones	Sonata*
Halcion*	Sporanox
Imitrex*	Stadol*
Immune Globulins	Tamiflu*
Increlex	Tazorac
Interferon Therapy	Tretin-X
Kapidex	Treximet
Kepivance	Tysabri
Lamisil	Xolair
Leukine	Zegerid*
Lunesta*	Zolinza
Lysosomal Storage Enzymes (Aldurazyme, Cerezyme, Elaprase, Fabrazyme, Myozyme)	Zomig*
Maxalt*	Zyvox*
Mobic
Myobloc
Naglazyme

* Indicates those drugs with an initial quantity allowance before Prior Approval is required.

Contact information

Call these numbers for additional prescription medicine information or assistance:

Retail Pharmacy Program (Standard Option and Basic Option)
1.800.624.5060
Monday through Friday
8 a.m. to 9 p.m. Eastern Time
Saturday, 8 a.m. to 6 p.m. Eastern Time

Mail Service Prescription Drug Program (Standard Option only)

1.800.262.7890
24 hours a day
7 days a week

Still have questions?

Call your local Blue Cross and Blue Shield Plan. The customer service number is on the back of your Service Benefit Plan ID card or use the Contact Us feature on this Web site.

The information provided here is a summary of the Service Benefit Plan benefits. For a complete description, refer to the 2008 Service Benefit Plan brochure (RI-71-005).

The medicine names listed in this publication are the registered and/or unregistered trademarks of third-party pharmaceutical companies unrelated to and unaffiliated with Caremark. These trademarks are included here for informational purposes only and are not intended to imply or suggest any affiliation between Caremark and such third-party pharmaceutical companies.

The 2008 Prescription Drug Benefits information is prepared by Caremark, with approval from the Blue Cross and Blue Shield Association.