State staff helped more than 12,600 Medicaid members who are due for critical medication refills over the weekend
February 29, 2024 – With the ongoing Change Healthcare network and system outages, Utah Medicaid is continuing to work with Utah pharmacies to make sure Medicaid members are able to access medications they need to stay alive or reduce risks for their behavioral health conditions.
“Despite many improvements in service for Medicaid members and their ability to get life-saving medications, we know there continue to be some lingering issues,” said Tracy Gruber, executive director of the Utah Department of Health and Human Services (DHHS). “We are grateful to the incredible partnership of health plans, pharmacies, retailers, and fellow state agencies, as we do everything we can to problem solve.”
Over the weekend, state staff made 21,000 outbound calls to members, with 12,600 resulting in speaking with the member or leaving a voicemail with general information related to the current pharmacy problem and how to navigate it.
More than 350 staff from DHHS and the Utah Department of Workforce Services worked through the weekend offering extended customer service hours. In addition to the outbound calls, Medicaid hotlines received more than 300 inbound calls from pharmacies and members needing assistance. Medicaid hotlines for both pharmacies and members will again be extended through the upcoming weekend from 8 a.m. to 5 p.m. both Saturday and Sunday.
“Utah pharmacies are taking on a monumental task using workaround pathways and overrides that are significantly more cumbersome and time consuming, in order to close the gap in care for Utah Medicaid members,” said Jen Strohecker, Utah Medicaid director. “Additionally, Medicaid health plans have actively worked to support Medicaid and its members, showing their commitment to this community. We are incredibly grateful for all the extra hands and hours this past week to reduce barriers and improve access for our members during this unprecedented time.”
“No one wanted to be in this situation,” said Dave Davis, president of the Utah Retail Merchants Association. “Our retail pharmacies across Utah are proud to stand with Medicaid to support our friends and neighbors in getting the medications they need.”
Utah Medicaid has asked pharmacies to provide up to a 30-day supply of medications at no cost to Medicaid members. 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.
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.
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 am to 5 pm. Additional resources and updates are on the Medicaid website.
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.
It is unknown as to when these disruptions will be resolved. Change Healthcare is providing updates on their website.
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