American Pharmacy Cooperative, Inc. (APCI), announced today that it is integrating its pharmacy audit services program into the co-op’s wholly owned pharmacy services administration organization. 

Weeks ago, OPA was made aware of one of the state’s Medicaid Managed Care Organizations (United Healthcare) moving to a limited, restrictive network, and that by March 1, 2015, approximately 800 pharmacies, ranging from large chains, small chains, and some independents, will be not be included in the new network.

We have since received many phone calls from frustrated pharmacists who are concerned about the possibility of cutting ties with long-time patients who have come to value the services they were receiving from their local pharmacy.

Last week, OPA staff sat down with the Director of the Department of Medicaid John McCarthy and some of his staff to discuss the ramifications for patients and pharmacies if restrictive networks are permitted within the managed care program. Unfortunately, there are no plans by the Department of Medicaid to prohibit restrictive networks by their managed care organizations; however, for patients who have been told by United Healthcare to use other pharmacies, there are still options for impacted patients.

For now, here is what you need to know...

First, because notices to patients of a change in their pharmacy networks were sent shortly after the enrollment period, there is an option for patients to change their enrollment to another managed care plan. According to the Department of Medicaid, if you encounter a patient who selected United Healthcare, and was under the impression that their current pharmacy was in-network, only to now be told that it isn’t, those patients will be allowed to switch managed care plans. This "open period" will extend through April 2015. Beginning May 1, 2015, this window will close, and patients will no longer be able to switch until the next open enrollment period begins.

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