CVS Pharmacy will stop accepting Horizon NJ Health insurance at New Jersey locations beginning April 30. The reported change disrupts prescription access for more than 800,000 residents enrolled in Medicaid and NJ Family Care.
Horizon NJ Health members will still be able to fill prescriptions at CVS, but will be required to pay full price. Members who use CVS as their primary pharmacy are urged to transfer medications to an in-network pharmacy.
Horizon NJ Health, a subsidiary of Horizon Blue Cross Blue Shield of New Jersey, said the move is the result of a contract dispute over reimbursement rates. Neither CVS or Horizon is accepting the blame.
“CVS Pharmacy submitted a proposal that was equitable and competitive with other New Jersey Medicaid plans, but Horizon rejected it and demanded rates that are unsustainable for our pharmacy business,” CVS said in a statement to NJ.com.
Horizon countered that CVS declined to negotiate acceptable pricing, instead choosing to leave the network.
The change affects only Horizon NJ Health’s Medicaid and FamilyCare plans. Commercial Horizon Blue Cross Blue Shield of New Jersey members can still fill prescriptions at CVS as they were.
CVS will remain in-network for other state-managed care health plans, including Aetna Better Health of New Jersey, Fidelis Care, UnitedHealthcare Community Plan, and Wellpoint.
Horizon NJ Health members are facing higher prescription costs unless they transfer to a viable in-network option. Other options include Walgreens and independent drugstores.
The inability for both parties to reach an agreement throws yet another obstacle in front of those already facing several. The shift is expected to hit hardest among patients who rely on CVS for ongoing prescriptions, particularly those managing chronic conditions or limited transportation options.
For Horizon NJ Health members, be prepared to switch before April 30.
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