Utah Medicaid continues to respond to pharmacy vendor network outage

Joe DoughertyFeatured News, Medicaid

17,000 Medicaid members who are due for critical medication refills will be contacted by staff this weekend

February 24, 2024 – As the Change Healthcare outage affecting pharmacy prescription information is expected to linger into next week, Utah Medicaid is taking the unprecedented step of personally calling 17,000 Medicaid members who are on high-risk or life-sustaining medication. 

Around 200 staff from the Medicaid team within the Utah Department of Health and Human Services (DHHS) and the Utah Department of Workforce Services will be contacting Medicaid members who are due for a refill of high-risk medication in the next 7 days, or March 2.

“We didn’t cause the problem, but we are owning a solution,” said Tracy Gruber, executive director of DHHS. “We owe it to our members to do everything we can so they can have the medication they need.”

For Medicaid members whose prescriptions will be due for refill between March 3-9, Utah Medicaid will continue to review the situation and member needs through the coming week and is prepared to make another round of contacts if the Change Healthcare outage is not resolved.

“We will do this as long as it takes,” said Gruber.

Who will be contacted

State staff will be contacting Medicaid members who need certain medications to stay alive or reduce risks for their behavioral health conditions. Some examples include medications for managing diabetes, cancer, blood pressure, epilepsy, asthma and breathing issues, pain, or hemophilia, as well as medications for supporting mental health or treating depression, anxiety, or substance use disorder. This is not a complete list of needs, but the types of conditions being targeted by state staff in direct calls this weekend. 

If members have questions, they can call Utah Medicaid at 1-866-608-9422. DHHS has extended customer service hours through the weekend from 8 a.m. to 5 p.m. both Saturday and Sunday.

For pharmacies

Utah Medicaid has advised pharmacies to provide up to a 30-day supply of medications at no cost to Medicaid members. 

We recognize that for pharmacies, many of which are independent, this may represent a financial burden. Utah Medicaid has created a system for interim reimbursement for pharmacies that are providing medications for Medicaid members. That process is being communicated directly to pharmacies so they can get reimbursed for these expenses within one week.

“We need Medicaid members to get their critical medications,” said Jen Strohecker, director of Utah Medicaid. “But we also need to make sure pharmacies don’t go out of business.”

Pharmacies with questions for Utah Medicaid can call the Medicaid pharmacy program at 801-538-6155 option 3,3,2 from 8 am to 5 pm both Saturday and Sunday this weekend in addition to the normal 8 am to 5 pm hours Monday through Friday next week. 

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 anticipates that these disruptions will last through the day, if not longer.  They are providing updates on their website.

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