Walgreens, Ohio’s second-largest pharmacy retailer, and CareSource, the state’s largest Medicaid managed-care plan have cut ties, according to Walgreens executives. Yet, with open enrollment starting on Friday, neither CareSource nor Ohio Medicaid have acknowledged the split, much less notified Medicaid recipients.

A Walgreens executive on Monday said he has known for weeks that early next year the pharmacy chain won’t be part of the pharmacy network for Ohio’s largest Medicaid managed-care provider, CareSource.

But with Ohio’s 2.5 million Medicaid patients poised to start picking a provider Friday for the coming year, neither CareSource nor the Ohio Department of Medicaid has definitively said whether CareSource’s patients will be able to use the state’s second-largest pharmacy chain to get their medicine.

That’s something they’ll likely want to know before deciding which of Ohio’s five Medicaid plans to pick for coverage.

What’s more, neither CareSource nor Walgreens will say whether the pharmacy will be part of the networks in three of the other states in which Dayton-based CareSource is a Medicaid managed-care provider: Indiana, Georgia and Kentucky.

Get the news delivered to your inbox: Sign up for our morning, afternoon and evening newsletters

Pharmacists and other experts say it’s especially important to notify Medicaid patients early when changes occur in their health plans. They tend to be sicker than the general population and often have communication and transportation challenges that can delay word reaching them about changes — and make it harder to adapt when they do hear about them.

“If you want the Medicaid population to be served at the highest level, you need to remove the obstacles you put in front of them,” said Lynne Fruth, president of a chain of 30 pharmacies that operates in southeastern Ohio, West Virginia and Kentucky. “You can’t keep telling them that they have to change pharmacies and doctors and all of those things.”

So far, Ohio Medicaid and CareSource, which serves 1.2 million Ohio Medicaid patients, haven’t acknowledged the latest obstacle, which is a big one.

On Saturday, The Dispatch reported that Walgreens, which has 252 pharmacies in Ohio, said it had been dropped from the CareSource network. Then on Monday, Walgreens President Alex Gourlay told investors of the split on the corporation’s fourth-quarter earnings call.

Asked about Walgreens’ departure from provider networks, he said, “Obviously, there’s been conversation high over the weekend … of which we were aware a few weeks ago … we’re disappointed that CareSource has taken this decision, but recognize that that’s their decision to take, but we have other gains to make (it) up in other networks,” he said, according to an audio recording of the call on Walgreens’ website.

For the past year-and-a-half, The Dispatch has been investigating the role of pharmacy benefit managers — middlemen in the drug supply chain who are hired by managed-care companies such as CareSource. The investigation has shown that through a series of non-transparent transactions, taxpayers have paid the middlemen far more than the middlemen have reimbursed pharmacies for their drugs.

Asked Tuesday if CareSource was delaying an announcement of the split to avoid losing patients during open enrollment, the company’s Ohio market President Steve Ringel said CareSource was “working through” a process with the Medicaid Department and that it was required to give the state four months notice of network changes.

“We will be proactively outreaching to our current members as soon as the timing is finalized,” he said. “Similarly, for any Ohio Medicaid member who is evaluating their plan choice during open enrollment, information about the likely pharmacy network change is included in our communications.”

Medicaid spokesman Kevin Walter seemed to acknowledge the importance of letting Ohio Medicaid recipients know whether Walgreens would be in their network before they choose a provider. Managed-care organization “directories and client information must reflect the network of providers and services. Consumers must have this information and the ability to change plans to meet their needs, if they so choose,” he said in an email.

Other states served by CareSource are even more in the dark. Neither CareSource nor Walgreens will say if they’re headed for a split in those places. In Kentucky, open enrollment begins Monday. In Georgia, it started last week.

George Reybold of the Georgia Pharmacists Association said whether Walgreens will be in the CareSource network is “something that we’re watching closely.” His group represents community pharmacists and, as in Ohio, none has yet seen a contract from CareSouce’s new pharmacy benefit manager, Express Scripts.

Pharmacists in both states have complained that Medicaid reimbursements are so low that they lose money filling them. They worry that Walgreens is leaving the CareSource network because its pharmacy benefit manager isn’t offering to reimburse the mega-chain adequately. They also worry that a Walgreens exit will force more money-losing business to their stores.

“Our concerns with Medicaid managed-care are many, but if (a Walgreens exit from CareSource) were to happen, that would be another,” Reybold said.

Dave Burke, chairman of the Ohio Senate’s Health, Human Services and Medicaid Committee, is also concerned because the Walgreens exit is happening despite attempts by the Ohio Department of Medicaid to improve reimbursements to pharmacies.

“If I were in Medicaid this would make my head snap,” the Marysville Republican said. “I’d ask myself, ‘What are we doing wrong?'”

But the biggest immediate concern is that early next year unsuspecting CareSource clients will go to Walgreens for lifesaving drugs such as insulin only to be told they’re not covered.

“How unfair is that to the Medicaid customer?” asked Andy Becker, Fruth Pharmacy’s director of pharmacy administration.

mschladen@dispatch.com

@martyschladen

Go to Source

1.2 million Ohio Medicaid recipients may be in dark over losing coverage for Walgreens – The Columbus Dispatch