Blue Shield of California in California

Blue Shield of California

For nearly 70 years, Blue Shield of California has distinguished itself with innovations that have changed the face of health care and made us a prominent force in the California healthcare market.

Throughout our history, Blue Shield has laid claim to several notable 'firsts' in the industry: in 1943, we offered the first health plan in the nation with coverage for pre-existing conditions under group programs; in 1950, we introduced the first catastrophic coverage in the nation; in 1984, we became the first health plan in California to offer online benefits and enrollment information; and in 2000, we introduced the state's first cross border HMO, Access Baja.

Our tradition of innovation continues in the 21st Century as we became the first health plan to propose statewide universal coverage.

Blue Shield of California's Facts at a Glance

Founded In: 1939

Number of Employees: ~4,500

Coverage Area: 1 state

Membership: 3 million members

Network: HMO plan members have access to more than 29,700 doctors and 300 hospitals, and PPO plan members have access to more than 49,700 doctors and 350 hospitals through Blue Shield of California

Blue Shield of California's Awards and recognitions

> Blue Shield continues to receive many awards for our industry-leading programs and services.

> Our 2006 Awards include The Webby Awards: 2006 Award Nominee for Best Insurance Website; The Web Marketing Association: Best Insurance Website; eHealthcare Leadership Awards, for blueshieldca.com: Best Business and Health Promotion Use of the Internet and Technology, Silver Award for Best Health/Health Care Content in the HMO/PPO/Other Insurer Category, and Gold Award for Best Overall Internet Site in the HMO/PPO/Other Insurer Category; National Committee for Quality Assurance: Accreditation status of Excellent -- the highest possible level -- based on a voluntary review of how a health plan ensures its members are receiving high-quality care; Best of Blue Awards: Innovations in Medical Pharmacy Management Award: Healthly Lifestyle Rewards.

> Our 2005 Awards include Strategic Health Care Communications: Distinction Award for mylifepath.com in eHealthcare Strategy & Trends; San Francisco Chamber of Commerce: Excellence in Business Award; Consortium Health Plans: Outstanding Quality and Commitment in the RFI Process for Blue Cross Blue Shield national account business; Best of Blue Awards: Best Practices in Quality Improvement: Patient Highlights: Effective Clinical Reminders for Physicians; Best Practices in Quality Improvement: Medical and Pharmacy Management; Direct Marketing Award: Healthy Lifestyle Rewards: Invest in Yourself; Internal Communications Award: Go the Extra MILE; Blue Awards: BlueWorks Quarterly Award (Third Quarter): Advanced Access.

> Our 2004 Awards include Best of Blue Awards: Innovations in Partnerships Award: Pay-for-Performance; Honorable Mention Innovations in Partnerships Award: Online Pharmacy Decision Support Services; Blue Awards: BlueWorks Quarterly Award (First Quarter): Partnerships for Improving Affordability and Quality.

> Our 2003 Awards include Best of Blue Awards: Low Cost/High Performing Award: Federal Employee Program; Best Practices in Partnerships Award: Medical and Pharmacy Management.

Blue Shield of California Subsidiaries

Blue Shield of California Life & Health Insurance Company, a Blue Shield wholly owned life and disability insurance subsidiary of Blue Shield of California.

Apply for California health insurance coverage at eHealthInsurance. We offer thousands of health plans underwritten by more than 180 of the nation's health insurance companies. Compare California health plans side by side, get health insurance quotes, apply online and find affordable health insurance today.

“Pig” Pharma & Prop 61, The Drug Price Relief Act

The panic over skyrocketing drug prices is growing exponentially. When it was mainly patients with rare diseases facing obscene price hikes for medicine, many Americans gritted their teeth and looked away, grateful it wasn’t their problem.

But now “trickle down” has a new meaning. More and more of us (including children) who have fairly common ailments like diabetes and allergies are suddenly discovering we cannot afford the medicines we depend on to live.

The outrageous mess with Mylan Pharmaceuticals’ EpiPen is only the most recent, glaring example, but the prices of insulin, Gleevac, Solvaldi and others are exploding too.

Per Michael Winship, senior writer for BillMoyers.com, in his article Drugs and Privilege: Big Business, Congress and the EpiPen(Nation of Change, 8/31/16):

“…this is one more, big old scam — yet another case of big business trying to pull the wool over the citizens’ eyes and pick our pockets while the government and our politicians mostly look the other way.”

But we can’t let the politicians look the other way! The problem is growing ever worse and something must be done about it. When the price of medicine is set beyond the reach of everyday people, they will suffer and die.

As reported this week in the Journal of the American Medical Association (8/30/16), The High Cost of Prescription Drugs in the United States (Harvard Medical School):

“Per capita prescription drug spending in the United States exceeds that in all other countries, largely driven by brand-name drug prices that have been increasing in recent years at rates far beyond the consumer price index.” 

Why is this happening? Researchers concluded:

“Drug prices are higher in the United States than in the rest of the industrialized world because, unlike that in nearly every other advanced nation, the US health care system allows manufacturers to set their own price for a given product.”

Note, the researchers did not conclude that drug prices are going up because of the usual excuses given by “Pig” Pharma, like “research is so expensive,” and so forth. In fact, they refuted these claims, pointing out that more than half of new pharmaceutical products had been developed from research funded by you and me – the taxpayers!

In fact, they found that the true causes of high drug prices are public policies that protect drug manufacturers’ competitive advantages and negotiating power. Yes,government-protected monopolies are driving drug prices higher.

By permitting unethical industry-wide practices such as Pay-for-Delay and Patent Evergreening, our political leaders are contributing to the problem.

In addition to allowing blatant patent tinkering, our political leaders also support and enforce FDA restrictions on importing drugs which, again, limit patients’ access to less expensive drugs from abroad. Add to that tax breaks and other regulatory shenanigans, and the American people are getting screwed over every which way.

Yet public policies and regulations can be changed. What’s the hold up? Why aren’t our politicians all over this?

Because “Pig” Pharma can well afford high-roller lobbyists, both at the federal and state level. And they do not hesitate to throw gobs of money around to get their way.

According to OpenSecrets.org, the pharmaceutical industry spent $240,218,911 on lobbying in 2015 alone. And what are they spending in California?

Good question! A brand new study* called Follow the Drug Dollars reveals that California Senators and Assembly Members are getting paid thousands, even tens of thousands, of dollars by the drug industry. In addition, California doctors, building trades unions, “advocacy” groups and more are also getting drug industry payoffs.

According to Follow the Drug Dollars :

“Some of these people and groups are the drug industry’s top paid mercenaries, giving a veneer of respectability to what is just a naked attempt by Big Pharma to protect its profiteering and obscene profits.”

It’s way past time to put a stop to all this.

Proposition 61, the Drug Price Relief Act, represents a bold first step at reining in “Pig” Pharma. Per David Lazarus, in his articleDrug Companies Spend Millions To Keep Charging High Prices (Sci-Tech Today, 8/26/2016):

“The Drug Price Relief Act would make prescription drugs more affordable for people in Medi-Cal and other state programs by requiring that California pay no more than what’s paid for the same drugs by the U.S. Department of Veterans Affairs. It would, in other words, protect state taxpayers from being ripped off.”

Sounds great, right? But read the article – “Pig” Pharma is gearing up to defeat it.

They are going to spend millions and millions of dollars (projections indicate up to $100 million) on advertising to convince you to vote against your own interest. They’ll set up fake organizations with names like “Californians for Sensible Drug Pricing” who will oppose Prop 61. They’ll get politicians to talk about how bad this will be for California’s economy. They’ll claim that Prop 61 will cause drug prices to go up.

Don’t fall for the BS! Prop 61 is good for California, it’s good for you and me.

It’s no secret that HEAL California seeks big solutions, like Improved, Expanded Medicare for All.

Prop 61 is only a step, but it is an incredibly important one. Prop 61 throws down the gauntlet to “Pig” Pharma, an industry that clearly is ready and willing to kill for their profits. We must take back control of our prescription medicine, and Prop 61 is the first step.

If you believe that health care should be about people, rather than profits, join HEAL California! Better healthcare is within reach, but we have to come together and fight for it.

Why insurers oppose a fantastic proposal to let California women have a year's supply of birth control

 On Monday, the California Senate is expected to approve a bill that would allow women to pick up a year’s worth of birth control pills at a time, instead of forcing them, as their health insurance companies so often do, to return to the pharmacy every month or every three months for refills.

A year's supply of contraception, studies show, reduces unwanted pregnancies, lowers the abortion rate and saves millions of dollars.  

“There is a need for consistent, uninterrupted contraception,” said the bill’s author, Democratic state Sen. Fran Pavley, when she introduced the measure, SB 999, at a committee hearing last week. It’s especially important, she said, for women who live in rural areas, or whose busy schedules make it difficult to get to the pharmacy to keep refilling a prescription. “It’s a bill whose time has come.”

I'll get to why in a moment, but first it’s important to understand why this modest proposal could have such a major impact.  

To get a handle on the issue, UC San Francisco researchers analyzed the birth control supplies and pregnancy rates among 84,401 California women. The study was conducted in 2011 based on data from 2006. Eleven percent of the women got a one-year supply of birth control, 58% got a three-month supply, and 20% got a one-month supply. Women who received only a 30-day or 90-day supply of contraception had a much higher rate of unintended pregnancy than women who took home a year's supply at a time.

Why is that? Because women work. They go to school. They don’t always plan things meticulously. If you are busy, or if you live in a rural community, refilling a birth control prescription can be a burden.

“Every time you have to stop and pick up your pills, that’s life getting in the way,” said Deborah Rotenberg, legal counsel for Planned Parenthood Affiliates of California, a cosponsor of the bill.

Yet, unlike blood pressure or cholesterol-lowering meds, where missing a day’s dose will not hurt you, missing a day or two of birth control pills can result in instant fertility — and an unwanted pregnancy.

Diana Greene Foster, the lead author of the UC San Francisco study, told the UCSF News Service  that providing only a month’s worth of oral contraceptives at a time to women is “similar to asking people to visit a clinic or pharmacy to renew their seat belts each month.”

A separate analysis by the California Health Benefits Review Program, which was created in 2002 to provide the Legislature with independent analyses of proposed health insurance mandates, found that fewer office visits and fewer unintended pregnancies would result in a savings of about $42.8 million a year. It also estimated a decrease of 15,000 unintended pregnancies per year (resulting in 6,000 fewer live births, 2,000 fewer miscarriages and 7,000 fewer abortions).  

“These kinds of results — from a research or medical standpoint — are just astounding,” Dr. Mitchell Creinin said when he testified last month at a state Senate hearing on the bill. Creinin is chief of family planning in the UC Davis Health System’s Department of Obstetrics and Gynecology.  “A 12-month supply… decreases pregnancy rates and abortion substantially. This is a life-altering change."

y the way, doctors generally write 12-month prescriptions. It's insurance companies that prevent women from receiving more than a 30- or 90-day supply, which is frustrating to physicians as well.

“We’re trying to remove barriers," said Creinin, "and we know that removing barriers when a woman is trying to prevent unintended pregnancy is important.”

Health insurance industry opposition to this bill is a head-scratcher.

Steffanie Watkins of the Assn. of California Life and Health Insurance Companies sounded almost regretful when she told state senators last month that her group opposes the bill because women might get a year's worth of pills and then not use them all. That just seems silly. Researchers found that a miniscule number of pills go unused. Anyway, compare the cost of a few wasted pills against the cost of prenatal care, plus labor and delivery. Or an abortion. It's not even close.

A conversation I had with Nicole Evans of the California Assn. of Health Care Plans was more on point.

“We have a standard position on benefit mandates,” she told me. “They drive up the cost of coverage.”

But, but, but, I said, there are studies showing this measure could save millions of dollars a year! Evans had not seen them, she said, and they didn’t really matter, since the position of the industry is that mandates drive up costs. (Even if they don't, I guess.)

“The bottom line is insurance companies don’t want to be told how to run their business,” said Kathy Kneer, president and CEO of Planned Parenthood Affiliates of California. “It’s a principle that’s near and dear to their heart.”

In 2013-2014, the California Health Benefits Review Program estimated, 744,000 California women between the ages of 15 and 44 were using hormone-based contraception like the pill, the patch or the vaginal ring. Only 5,000 women received a 12-month supply. If Pavley's bill becomes law, that number could jump to 285,000.

To get a sense of how the law might affect a real person, I put in a call to my reliable, one-woman reproductive rights focus group. She’s a 23-year-old college graduate who works in a San Francisco medical clinic.

I told her about the proposal, which will need to be approved by the state Assembly and signed by the governor before it becomes law.

“Oh thank God!” my daughter, Chloe, practically shouted into my ear. “That was such a rude awakening for me — that you have to go to the pharmacy every month for your pills! It’s such a hassle! What if you can’t get your [act] together to go pick them up? That happened to my friend. She got pregnant and had to have an abortion.”

I have no idea why insurance companies are resisting a common sense proposal to make contraception less onerous for women. It’s a foolish kind of consistency that puts principles before the needs of real, live human beings.