Despite progress on system restoration, pharmacies will continue to need to use temporary workarounds for Medicaid members
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March 8, 2024 – After more than two weeks of network and system outages, Change Healthcare is closer to a restoration of pharmacy claims processing and payment for Utah Medicaid members.
While Change Healthcare has indicated that claim submission and payment transmission for pharmacy services is functioning as of yesterday, this does not apply to Utah Medicaid pharmacy operations.
“We are working closely with Change Healthcare to get systems back in operation, but critical parts of the process for Utah Medicaid are still not online,” said Tracy Gruber, executive director of the Utah Department of Health and Human Services. “Utah pharmacies will need to continue to use the temporary workarounds that they have been using since the system outages.”
Medicaid has asked pharmacies to provide up to a 30-day supply of medications at no cost to Medicaid members. Utah Medicaid created a system for interim reimbursement for pharmacies and other impacted providers that are providing medications and services to Medicaid members. That process is being communicated directly to pharmacies and impacted providers so they can get reimbursed for these expenses within one week.
“Utah Medicaid has been using a simple Google form in the interim to cover pharmacy costs and reduce the short-term financial burden this has put on Utah businesses,” said Jen Strohecker, Utah Medicaid director. “Since implementing this emergency workaround, Medicaid has paid more than $1.3 million in pharmaceutical claims to more than 114 providers in the last two weeks. We are grateful to the pharmacies who continue to serve Medicaid members during this challenging time.”
Pharmacies with questions can call the Medicaid pharmacy program at 801-538-6155 option 3,3,2 from 8 am to 5 pm, Monday through Friday. Additional resources and updates are on the Medicaid website.
Medicaid does not want any member to have delayed care as a result of this system issue. If members have questions, they can call Utah Medicaid at 1-866-608-9422 from 8 a.m. to 5 p.m., Monday through Friday.
As soon as Change Healthcare is able to restore pharmacy system services to Utah Medicaid, DHHS will notify providers, pharmacies, stakeholders, elected officials, and Medicaid members.
Background
On Wednesday, February 21, Change Healthcare, which operates as the Utah Medicaid pharmacy vendor for members whose prescriptions are paid directly by Medicaid (known as fee for service), reported they were experiencing a cyber security issue on their systems. Change Healthcare took immediate action and disconnected their systems to reduce further impact.
With the network and system outages, Medicaid staff have been unable to access any pharmacy claim information, including placing overrides and prior authorization information for these members. This outage is impacting Medicaid members who are attempting to fill a prescription and are not enrolled in a managed care plan or seeking to fill a behavioral health medication.
This issue is not limited to Utah Medicaid members and providers. Change Healthcare, and its parent company, Optum, provide technology and data to insurance companies and healthcare services nationally.
Change Healthcare is providing updates on their website.
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