What's Happening?
CVS Pharmacy will no longer be considered in-network for Medicaid users under Horizon NJ Health starting this spring. This change is due to a disagreement over prescription cost rates between CVS and Horizon NJ Health, a part of Horizon Blue Cross Blue Shield
of New Jersey. CVS had proposed a rate increase, which Horizon NJ Health rejected, citing that it would significantly raise costs for members and taxpayers without additional benefits. As a result, nearly 1 million Medicaid customers in New Jersey will lose access to over 340 CVS pharmacy locations, including 24-hour and drive-thru pharmacies, as well as those inside Target stores. CVS will remain in-network for other New Jersey Managed Medicaid Plans and Horizon NJ Health's commercial network.
Why It's Important?
This development is significant as it impacts a large number of Medicaid users in New Jersey, potentially disrupting their access to necessary medications. The disagreement highlights ongoing tensions between healthcare providers and insurers over drug pricing, which can affect healthcare affordability and accessibility. For Horizon NJ Health members, this change could mean finding new pharmacies, which may not be as convenient or accessible as CVS locations. The situation underscores broader issues in the healthcare system, where cost negotiations can directly affect patient care and access.
What's Next?
The termination of CVS as an in-network provider for Horizon NJ Health Medicaid users is set to take effect after April 30. Until then, affected customers will need to find alternative pharmacies to fill their prescriptions. Horizon NJ Health and CVS may face pressure from customers and advocacy groups to reach a new agreement. Additionally, this situation could prompt discussions among policymakers about the regulation of drug pricing and the role of large pharmacy chains in Medicaid networks.
