Plans to temporarily pay independent and safety-net pharmacies to support MaineCare members' access to medications in response to Change Healthcare outage
AUGUSTA– The Department of Health and Human Services (DHHS) announced today that it has developed an interim payment system for independent and safety net pharmacies in response to the continued disruption of the pharmacy claims system for MaineCare, Maine’s Medicaid program.
This disruption results from a cybersecurity issue affecting Change Healthcare nationally, impacting health care systems and Medicaid members in many states. This week, the Office of MaineCare Services will issue interim payments to help keep pharmacy doors open to MaineCare members, sustaining pharmacies that may otherwise be unable to continue service in the absence of MaineCare reimbursement.
“We continue to strive to limit the impact of this national disruption on MaineCare members and the pharmacies doing their best to serve them during unprecedented circumstances,” said DHHS Commissioner Jeanne Lambrew. “These interim payments are designed to sustain the local Maine pharmacies most financially challenged by this disruption in the short term as we continue to respond. We are grateful for the partnership of Maine pharmacies and health providers in serving Maine people who need their medications.”
MaineCare has identified about 40 Maine pharmacy organizations operating approximately 60 locations to receive the interim payments, which are independent, part of small Maine chains, and/or serve as safety net providers for low-income residents. The Department is defining “safety net” pharmacies as those that operate in federally-qualified health centers, Critical Access Hospitals, and long-term care facilities. At this time, pharmacies that are part of health systems and large multi-state chains are not included.
The amount of the interim payment equals the average weekly MaineCare reimbursement to each qualifying pharmacy before the disruption. The payment made the week of March 4 will cover both the weeks of February 26 and March 4. The Department will issue these interim weekly payments beginning Wednesday, March 6. Pharmacies should receive payment this Thursday or Friday depending on their bank and payment specifications. Pharmacies do not need to apply for this interim payment but will be subject to reconciliation of payments once the disruption ends. The list of qualifying pharmacies is here (PDF).
Once Change Healthcare resumes operations, the Department will provide retrospective reimbursement back to February 21, 2024, the first day of the system outage, for all pharmacies serving MaineCare members. The interim payments will be accounted for during this process.
DHHS will assess the need and feasibility of extending interim payments to additional pharmacies.
To reach DHHS about this issue:
- Pharmacies with questions about the interim payments may call the MaineCare Provider Relations pharmacy representative at (207) 624–4012.
- Pharmacies checking individuals' MaineCare eligibility may call MaineCare Provider Services at 1–866–690–5585 or check the Health PAS Online Portal.
- MaineCare members experiencing trouble getting their prescriptions filled may call the MaineCare Pharmacy Help Desk at 1–866–796–2463. They may experience delays due to call volume.
MaineCare has been working with members, pharmacies, and providers in response to the cyber security issue, which prompted Change Healthcare to shut down its systems on February 21, 2024. Since then, MaineCare has been temporarily unable to pay pharmacies for filling prescriptions for MaineCare members. On February 27, 2024, DHHS’s Office of MaineCare Services authorized pharmacies to provide prescriptions for up to 30 days to help MaineCare members access needed medications, extending a three-day authorization issued on February 23, 2024.
While DHHS works on temporary and permanent payment systems for pharmacies, pharmacies should neither turn away nor ask MaineCare members to pay out of pocket for any prescription that is covered by MaineCare. Such prescriptions may be needed for urgent illness as well as chronic conditions.
DHHS is in close communication with Change Healthcare about its timeline for resolving these issues and returning to business as usual.
MaineCare takes the security of members' personal information seriously. Change Healthcare has not indicated that any personal data of MaineCare members was improperly accessed as part of the network disruption.
The Department will share further updates as information becomes available.