6/3/2025
A pharmacy claims processing system error impacted Blue Shield IFP and Commercial group members with integrated pharmacy and medical accumulators. The processing errors caused pharmacy claims to over-accrue for impacted members beginning January 1, 2025, and continuing through March 21, 2025, when the system error was corrected.
Blue Shield and Abarca Health, their pharmacy benefits and claims vendor, are working together to review and reprocess all impacted member claims.
Members who continued to pay out-of-pocket for prescriptions beyond their plan benefits will be issued a refund. Refunds began issuing on May 7, 2025, and are expected to continue into early June when all relevant claims have been reviewed and reprocessed. Members do not need to take any action to be issued a refund. The refund check will come from Abarca, a name with which members may not be familiar. In way of explanation, a separate member letter identifying Blue Shield and the issue will precede the refund mailing from Abarca.
Self-funded groups may experience an adjustment in their claims reporting aligned with the cost of refunds sent to the members due to overpayment by the member.
Blue Shield and Abarca Health, their pharmacy benefits and claims vendor, are working together to review and reprocess all impacted member claims.
Members who continued to pay out-of-pocket for prescriptions beyond their plan benefits will be issued a refund. Refunds began issuing on May 7, 2025, and are expected to continue into early June when all relevant claims have been reviewed and reprocessed. Members do not need to take any action to be issued a refund. The refund check will come from Abarca, a name with which members may not be familiar. In way of explanation, a separate member letter identifying Blue Shield and the issue will precede the refund mailing from Abarca.
Self-funded groups may experience an adjustment in their claims reporting aligned with the cost of refunds sent to the members due to overpayment by the member.
Source: Blue Shield of California