More than 850,000 members of Horizon NJ Health, the managed Medicaid plan operated by Horizon Blue Cross Blue Shield of New Jersey, will lose in-network access to CVS pharmacies after April 30.
The insurer is advising affected members to transfer their prescriptions to another in-network pharmacy before the change takes effect. The change does not impact Horizon NJ TotalCare (HMO D-SNP) or Horizon’s commercial members.
“Last fall, CVS notified Horizon NJ Health that it would leave our Medicaid network unless we agreed to a substantial increase in the cost of prescriptions for our members,” a Horizon spokesperson told Becker’s. “Unfortunately, CVS refused to negotiate a fair price and chose instead to leave our Medicaid pharmacy network.”
“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,” a CVS spokesperson told Becker’s.
Neither spokesperson confirmed whether negotiations are still ongoing.
Horizon NJ Health beneficiaries will lose in-network access to more than 340 CVS locations in New Jersey.
CVS Pharmacy remains in network with the other managed Medicaid plans in the state: Aetna, Fidelis, UnitedHealthcare and Wellpoint.
