CDPHP subscribers on Medicaid to lose CVS access

CDPHP subscribers on Medicaid to lose CVS access

ALBANY — Some CDPHP subscribers will lose access to prescription drug coverage and services at CVS pharmacies through the end of the month.

Starting Jan. 31, 2023, the drugstore chain will be out-of-network for patients on Medicaid and health and recovery plans (HARP) because of its unwillingness to negotiate on drug costs, the New York-based insurance provider confirmed Tuesday. Albany.

According to Eileen Wood, chief pharmacy officer at CDPHP, a recent increase in health care costs – driven in part by rising prescription drug prices – continues to present significant financial challenges for CDPHP and its members.

“Contributing to the affordability crisis, CVS pharmacies have been unwilling to meet the prices agreed upon by all other independent, retail and grocery stores, driving up costs and making health care unsustainable for our community,” Wood said in a statement. With that in mind, and in the best interest of our members, CDPHP has made the difficult decision to remove CVS pharmacies from our Medicaid pharmacy network.”

The change does not apply to commercial members of CDPHP, Medicare, Child Health Plus or Essential Plan.

While CVS pharmacies remain in-network for those members, CVS has opted out of CDPHP’s Rx for Less money-saving program, which allows members to buy dozens of generic medications for a penny a pill. As a result, CVS medications may be more expensive.

“CDPHP is confident that consumers will continue to have access to timely and affordable medications and is proud to be partnering with a new pharmacy benefit manager, Capital Rx, which is adding hundreds of new independent pharmacies, with retail and grocery stores at the CDPHP pharmacy. network, which means CDPHP members will have even greater choice when purchasing more affordable medications,” Wood said.

The plan, which is the largest in the Capital Region, says it is working closely with members, health care providers and government entities to notify consumers of the change in the CDPHP Medicaid pharmacy network, ensuring there are no disruptions. in care.

New York sets reimbursement rates for Medicaid. The prices CVS charges for prescriptions exceed those reimbursement rates, which has resulted in CDPHP losing $1 million a month, according to CDPHP.

The pharmacy giant, which includes under its umbrella major insurance provider Aetna and the pharmacy benefit manager, which processes prescription drug insurance claims and negotiates with pharmaceutical companies, has major influence over prescription drug prices in USA.

The US Federal Trade Commission in June launched an investigation into the role of pharmacy benefit managers like CVS’ Caremark in driving up prescription drug costs. The state attorney general’s office is also looking into CVS’s alleged anticompetitive practices.

A CVS representative could not immediately be reached for comment.

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