In 2022, Centene and Express Scripts announced that beginning in January 2024, Express Scripts will manage pharmacy benefits for over 20 million Centene patients. In this new partnership, Centene will be transitioning over from its current PBM, CVS Caremark, to Express Scripts. Although the parties involved have ensured it will be a seamless transition, there are several recent events pharmacies should be aware of.
As of date, pharmacies were processing claims for Centene patients under their CVS Caremark provider contract, but starting next month, pharmacies will be doing so under their Express Scripts’ provider contract. Needless to say, this transition will require that pharmacies have an active provider contract in place with Express Scripts to be able to continue servicing their existing Centene patients. If pharmacies do not currently have an active Express Scripts agreement in place, their patients may have gotten or will be getting notices from Centene that inform them that their current pharmacy will no longer be an active provider in their networks effective January 1, 2024. Instead, Centene will identify alternate pharmacies in their network for patients to select from.
Similarly, it has been observed that several providers have been getting removed during this transition. For example, while one pharmacy location may have been previously terminated by Centene, another pharmacy under common ownership may have been allowed to maintain its participation in Centene’s network. However, the current transition to ESI has caused several providers to now be terminated or removed from Centene’s network despite previously being allowed to continue participation in Centene’s networks, solely because a commonly owned location may have been terminated in the past. In such instances, pharmacies have been observed to be terminated with little to no notice from either Centene or Express Scripts. To that end, several pharmacies have also been informed that Centene is electing its right to limit participation in its networks to a restricted number of pharmacies. That said, pharmacies should ensure that there is in fact a seamless transition next month and that they are able to continue servicing their Centene patients without any interruption.
How Can Frier Levitt Help
If your pharmacy is facing network interruption because of this transition, or if you have been previously terminated from Centene’s network or Express Scripts’ networks, please contact Frier Levitt to speak to an attorney today.
