alt=Emily AshcraftThe Utah Department of Health and Human Services is seeking to reduce the impact of a vendor network outage that is keeping Medicaid members from filling their prescriptions.
"We didn't cause the problem, but we are owning a solution," said Tracy Gruber, executive director of the department.
She said the department will do everything it can to get needed medications to its Medicaid members and is contacting the 17,000 Utahns who are on high-risk and life-sustaining medication.
Change Healthcare, the pharmacy vendor for Utah Medicaid prescriptions paid directly by Medicaid, reported a cybersecurity issue on Wednesday that led it to disconnect its system. Since then, Medicaid staff members have been unable to access pharmacy claim information and are unable to place overrides and prior authorization information.
This means pharmacies have been unable to be paid by Medicaid for prescriptions filled since Wednesday. Utah pharmacies have needed to decide whether they are willing to fill prescriptions and hope to receive payment later or require Medicaid members to pay in cash in order to receive medications.
Utah's state health department is advising pharmacies to provide a 30-day supply of medications at no cost to these Medicaid members, a statement released on Saturday says.
"We recognize that for pharmacies, many of which are independent, this may represent a financial burden," it reads.
The department said it has created a system for reimbursement, and the process will be communicated to pharmacies so they can be reimbursed for the prescriptions within a week of filling them.
"We need Medicaid members to get their critical medications, but we also need to make sure pharmacies don't go out of business," said Jennifer Strohecker, director of Utah Medicaid.
Change Healthcare, which is part of the company Optum, has given frequent reports since Wednesday saying the outage continues. Optum provides technology to insurance and health care companies around the country.
The latest report says Optum will not take shortcuts or risks in bringing its system back online, and the disruption is expected to last at least through the day on Monday.
Gruber said if the outage is not resolved soon, the Utah health department is prepared to make another round of phone calls to members of Utah Medicaid who have prescriptions due for refill in the week beginning March 3
"We will do this as long as it takes," she said.
The department extended customer service hours over the weekend and accepted calls from patients and pharmacies on Saturday and Sunday.