Walgreens said that it disputes the way state documents show CareSource characterized the reason the two are going out-of-network.
Dayton-based CareSource, which covers 1.2 million Ohioans through its Medicaid plan, received state approval Wednesday so its Ohio Medicaid plan can drop Walgreens as an in-network pharmacy starting Feb. 1, in a move that could affect 90,000 of its customers statewide.
In the Dayton area it would take 24 Walgreens pharmacies out of network.
FIRST REPORT: Details emerge in CareSource network change
Roxanne Richardson, deputy director of Ohio Medicaid’s Office of Managed Care, said a letter approving the move that “CareSource informed us that Walgreens would be willing to continue a business relationship with them, if CareSource would eliminate other pharmacies from its network. Should CareSource maintain Walgreens within their pharmacy network some counties could experience access issues if they eliminated other pharmacies (e.g. grocers) in an effort to maintain Walgreens.”
The pharmacy chain said in a statement Thursday that their latest proposal to CareSource was for a network that included CVS, independent pharmacies as well as others.
The letter said CareSource “has detailed a transition plan including early notification to members and prescribers, transitioning member prescriptions beginning with ODM’s (Ohio Medicaid) approval and data analysis of claims denials and subsequent claim approvals.”
CareSource Ohio Market President Steve Ringel had said the network change is part of the insurer’s efforts to build a network of pharmacies that are willing to commit to payment models where they get paid for quality.
According to CareSource pharmacy data, the Walgreens exit impacts members who use the pharmacy for routine maintenance medications or medications used to treat chronic conditions.
CareSource said 99% of all Ohio Walgreens locations have a CareSource in-network pharmacy located in close proximity, within no more than 2.2 miles.
Now that the change has been finalized with Ohio Medicaid, CareSource members will receive a letter highlighting nearby pharmacy options. Members can pick a different plan if they believe CareSource can no longer meet their needs as a result of this change.
Walgreens is also still in-network for two other Medicaid plans in Ohio, UnitedHealthcare Community Plan and Paramount Advantage. Ohio Department of Medicaid members can get enrollment help by calling 1-800-324-8680.
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