Commitment to Service Excellence Amid Switch Provider Event

Change Healthcare, a division of Optum, announced on February 21, 2024, that it is experiencing a cybersecurity event, impacting approximately 30% of pharmacies across the United States. It is paramount to note that there is no breach of any information within the Navitus, EpiphanyRx or Lumicera systems. 

To help members and clients better understand the impact, here is an overview of how switch providers operate within the industry, how the security event might affect members and steps members can take to get their prescriptions filled as seamlessly as possible.

What is a switch provider? As the name suggests, it is an entity that provides a point of connection and transfer. When a member takes a prescription to a pharmacy, the pharmacist needs to send out a digital request for processing that request or claim. The switch provider routes that claim to the necessary plan or payor and communicates back to the pharmacist with coverage details. When that switch point is disrupted, the pharmacy can’t process the claim. 

How does the Change Healthcare event affect Navitus, EpiphanyRx and Lumicera? All of our data and the data of our plans and members within our systems is secure. Lumicera, our specialty care pharmacy, is continuing prescription fulfillment. 

How does this impact members? We recognize that members may feel the impacts at the pharmacy counter, especially if you get prescriptions filled at an affected pharmacy. 

If you are a member and experiencing issues with prescription coverage:

• Ask your pharmacy what options they have available. Many pharmacies have alternative methods to process or track claims when systems are down.
• Inquire about a ‘good faith dispensing’ of the medication. If you have received the medication previously, the pharmacy may provide your medication based on past coverage and submit the claim when systems are running again. 
• Pay for the prescription at the counter. Many pharmacies will provide smaller supply quantities to make this more affordable. You can submit a direct member reimbursement claim and receive reimbursement. 
• Call Customer Care for additional support. Members can find these numbers on the backs of their member ID cards.

If a pharmacy informs you that the prescription is not covered, that may be based on disrupted communication rather than an actual change in coverage.

For the most current status of the Change Healthcare event, visit their Solution Status Updates page.

We will continue monitoring the situation and work to ensure that members, patients, clients and payors receive excellent service – a hallmark of our organization and commitment to helping human beings.