EOHHS and Medicaid Respond to Pharmacy Vendor Network Disruption

Published on Monday, March 04, 2024

Program implements new system for pharmacies to process claims

CRANSTON, R.I. – The Rhode Island Executive Office of Health and Human Services (EOHHS) and its Medicaid program are responding to a disruption caused by a cyber security issue affecting Change Healthcare, an out-of-state vendor that operates Medicaid pharmacy claims systems in many states including here in Rhode Island.

On February 21^st, 2024, Change Healthcare (owned by parent company Optum) experienced a cyberattack, which has taken the company’s systems offline. This meant that Rhode Island Medicaid was temporarily unable to pay pharmacies for filling prescriptions for its members through the usual system.

In response, RI EOHHS has quickly brought online a new way for pharmacies to process claims. Teams were working throughout the weekend to ensure this new system was ready as soon as possible and to minimize customer impact. The agency also requested that all pharmacies follow policies from the pharmacy provider manual and authorized pharmacies to provide prescriptions for up to 30 days to help impacted Medicaid members access needed medications. EOHHS asked pharmacies to continue to fill members' prescriptions as written by providers and process claims as normal. EOHHS/Medicaid will pay all eligible claims submitted by pharmacies. 

“It’s critically important that our Medicaid members have and maintain access to their prescriptions,” said Rhode Island Medicaid Director Kristin Sousa. “While we work on temporary and permanent payment systems, pharmacies should not turn away or ask members to pay out of pocket for any prescription that is covered by Medicaid. We recognize the challenges our members are facing, and we will continue to do all we can to limit the impact of this disruption. We thank pharmacies for their help in ensuring access to needed medications under these circumstances.”

Change Healthcare has not indicated that any personal data of Rhode Island members was improperly accessed as part of the network disruption.

EOHHS is in close communication with federal partners at Centers for Medicare & Medicaid Services (CMS), the National Association of Medicaid Directors (NAMD) and Medicaid programs throughout the country to share resources and information. The agency is also in regular communication with Change Healthcare about its timeline for resolving these issues and returning to business as usual.

EOHHS understands that this situation has created questions and challenges for Medicaid members and pharmacies alike. The office will share further updates as information becomes available. For the latest information, please visit EOHHS’ website at www.eohhs.ri.gov or Stay Covered RI at www.staycovered.ri.gov.