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Priority Health - Medicaid Pharmacy NEW Narrow Network

December 4, 2017

Effective December 1, 2017 Priority Health will utilize a select, limited group of pharmacies as preferred for all outpatient Medicaid prescription fills.

In our Medicaid service regions (West Michigan and Southwest Michigan) there will remain approximately 220 approved pharmacies where patients can have prescriptions filled.   Many large retail stores will continue to be in the Priority Health Medicaid pharmacy network, such as:

·         Walmart

·         Meijer

·         Walgreens

·         Costco

·         SAM’s club

·         Hometown pharmacies

·         Many smaller/local pharmacies

Some pharmacies no longer approved for Priority Health Medicaid member prescription fills include:

·         Rite Aid

·         CVS

·         Family Fare

 

A full disruption analysis was completed through Express Scripts Inc. (ESI), our pharmacy benefit administrator, to ensure that there was a clear understanding of how this change would affect members. We worked closely with ESI who assures us that the in-network, pharmacies are within a reasonable distance of the members’ residence.  In cases where distance to pharmacy may be a concern, such as in rural settings, Express Scripts is continuing to attempt to contract with pharmacies so they can be part of the network and service the Priority Health Medicaid population.  Additionally, for individuals with transportation challenges, Priority Health covers the cost of transportation.

 

A letter was sent October 1st to all Medicaid patients currently using a pharmacy that will soon be considered out of network.  In the letter, the nearest contracted pharmacy information was provided, but if your members need assistance in determining an in-network pharmacy, they are encouraged to sign in at express-scripts.com and click Prescriptions, then Find a Pharmacy or call ESI at 800.282.2881.

 

Pharmacies that will no longer be in the Priority Health Medicaid network are under strict rules to continue to fill Medicaid member prescriptions through 11/30/17 and to not turn members away prior to the 12/1/17 network change date.