WASHINGTON, D.C. (March 1, 2024) – As the Change Healthcare outage is now in its second week, the pharmacy community continues to be challenged and frustrated by the significant impact this has on pharmacies, pharmacy teams, and patients — from both an access to care and an economic perspective. Pharmacies are struggling or — in some cases — unable to process prescription claims, some have not received e-prescriptions for a full week, and many cannot process manufacturer patient assistance copay cards, which patients rely on.
Despite this chaos, pharmacies and pharmacists are making good faith efforts to provide continuity of patient care and, in many cases, working with no or little information about a prescription’s coverage details. This is creating backlogs, workflow disruptions, and an inability to provide patient care.
Association executives from the American Pharmacists Association (APhA), the National Community Pharmacists Association (NCPA), the National Alliance of State Pharmacy Associations (NASPA), and the American Society of Consultant Pharmacists (ASCP) released an open letter to pharmacy benefit manager (PBM) executives and other insurance payers whose systems may have been impacted by the Change Healthcare outage. Pharmacists and pharmacies are asking for assurances that claims fulfilled during this outage will be paid, and paid in a timely manner, considering the challenges faced by pharmacies and pharmacists with predicting co-payments and determining eligibility and coverage.
As always, pharmacies and pharmacists acted in good faith with patient care at the center of their decisions and met the needs of patients in accessing their medications and treatments. These frontline health care providers must be made whole when services are restored. This emergency has been ongoing since Wednesday, Feb. 21, and has yet to be resolved.
The pharmacy organizations also asked Change Healthcare to work with the appropriate partners to expeditiously implement less onerous means for all willing pharmacies to process impacted manufacturer patient assistance programs.
It is unclear when systems will be back to pre-outage functioning and fully recovered, so this needs to be addressed urgently. APhA, NCPA, NASPA, and ASCP stand ready to work with all organizations to disseminate information about the status of the outage as a whole, as well as their efforts related to impacted manufacturer patient assistance programs.
The open letter to PBM executives can be found here.
The letter to Change Healthcare can be found here.
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