On Tuesday, UnitedHealth confirmed that 90 percent of the country’s 70,000 pharmacies had to adjust their claims processing to mitigate the cyberattack last week on its data and analytics company Change Healthcare, which exchanges information between prescribers and PBMs. As a result, pharmacy teams have had to hustle to process pharmacy claims by finding work-arounds amid a lackluster response from most PBMs, who have offered no guidance on how to improve the situation.
NCPA CEO Douglas Hoey and Ronna Hauser, senior vice president for pharmacy and policy affairs, met with top executives from OptumRx this week, “to make clear,” says Hoey, "that pharmacies must not be left holding the bag” as they go to extraordinary efforts to ensure patients are cared for while Change Healthcare’s systems are down — emphasizing frustrations that communications to community pharmacies thus far have been inadequate to non-existent.
“Pharmacies need realistic estimates about restoration of claims and e-prescription routing and assurance they will not be penalized for making their best efforts to make sure patients get the medications they need,” said Hoey and Hauser.
As business interruption spills into a second workweek, NCPA continues to call on Change Healthcare and PBMs to provide clearer information to pharmacies left in the lurch because of the cyber attack. We have been in contact with CMS to request coverage waivers for the Medicare and Medicaid programs to protect pharmacies and with PCMA to suggest ways commercial plans can support their pharmacy networks.
“There has been very little communication out there,” NCPA’s senior vice president of special projects and relationships Patrick Berryman told Managed Healthcare Executive in an article published Tuesday, echoing Hoey and Hauser, and citing the uncertainty about claims, drug coverage, and copays that puts the risk squarely with pharmacies. Stay tuned to qAM for more as it develops.
