BlueCross BlueShield Member Story

Timely Intervention Prevents Medication Disruption For High-Risk Member

A 64-year-old member enrolled in the Elderly Waiver Program relies on ongoing medical treatment to manage multiple chronic conditions, including congestive heart failure, hypertension, diabetes, hyperlipidemia, anxiety, gastroesophageal reflux disease, sciatica, end-stage renal disease requiring dialysis three times per week, and a history of stroke. Maintaining consistent access to prescribed medications is critical to supporting her health and preventing complications.

While attending a scheduled dialysis session, an unexpected incident threatened the continuity of her care. A patient care attendant accidentally dropped two bottles of the member's medication, causing the contents to spill and become unusable. Faced with the possibility of missing critical medications, the member was advised by the dialysis center to contact her health plan for assistance.

The member quickly reached out to her Care Coordinator, who recognized the urgency and took action immediately. The Care Coordinator worked with the member to contact Member Services and participated in a conference call to explain the circumstances and get a resolution. During the call, a representative from Member Services worked directly with Prime Pharmacy to secure approval for replacement medications.

Thanks to the coordinated efforts of the member, the Care Coordinator, Member Services and Prime Pharmacy, a 30-day replacement supply of the medications was approved and provided the same day. The prompt response ensured there was no interruption in the member's treatment regimen and eliminated the risk of adverse health outcomes associated with missed doses. The member expressed gratitude and relief.



This successful outcome demonstrates the value of proactive care coordination, strong advocacy and effective collaboration in removing barriers to care. By acting swiftly and working together, the care team preserved the member's treatment plan, protected her health stability and reinforced her ability to remain safe and independent in the community.