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Medicaid users under Horizon NJ Health may need to switch where they pick up their prescriptions this spring, as CVS Pharmacy locations are to be no longer considered in-network for patients.
The parting of ways was caused by rate disagreements between the pharmaceutical company and the insurance network.
According to a statement from Horizon NJ Health — which is part of Horizon Blue Cross Blue Shield of New Jersey — CVS informed the insurance company that it would leave the Medicaid network “unless [they] agreed to a substantial increase in the cost of prescriptions for our members.”
“At a time when too many are already struggling with skyrocketing health care costs and the State’s Medicaid program is being financially strained, CVS’ demand would significantly raise the cost of prescription drugs for Horizon members and the taxpayers who fund Medicaid without delivering any additional benefits,” the Horizon NJ Health statement said.
CVS also gave a statement to this publication, saying that the company had “submitted a proposal that was equitable and competitive with other New Jersey Medicaid plans, but Horizon rejected it and demanded rates that are unsustainable for our pharmacy business.”
Horizon NJ Health claimed that CVS “refused to negotiate a fair price,” instead opting to leave the company’s Medicaid pharmacy network.
The details of the proposal were not disclosed by either party.
As a result of the two entities’ failure to reach an agreement, the CVS statement said that nearly 1 million customers on Medicaid will lose access to more than 340 pharmacy locations in New Jersey, including 25 24-hour pharmacies, more than 200 drive-thru pharmacies and more than 50 pharmacies found inside Target shopping centers.
According to a representative of Horizon NJ Health, a little less than 1 million New Jersey consumers used the Medicaid service as of Dec. 31, though not all use CVS for their prescriptions.
CVS in the state will remain in-network for other New Jersey Managed Medicaid Plans, as well as for Horizon NJ Health’s commercial network.
The pharmacy is to remain in-network through April 30 until the termination goes into effect.
Kaitlyn McCormick writes about politics, education and trending news across South Jersey for the Courier-Post, The Daily Journal and the Burlington County Times. If you have a story she should tell, email her at kmccormick@usatodayco.com. And subscribe to stay up to date on the news you need.
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