Have you encountered preferred or restrictive networks lately?

Because notices to patients of a change in their pharmacy networks were sent shortly after the enrollment period, there is an option for patients to change their enrollment to another managed care plan. According to the Department of Medicaid, if you encounter a patient who selected a Managed Care Plan, and was under the impression that their current pharmacy was in-network for that plan, only to now be told that it isn’t, those patients will be allowed to switch managed care plans. This "open period" will extend through April 2015. Beginning May 1, 2015, this window will close, and patients will no longer be able to switch until the next open enrollment period begins.

  • If a patient wishes to change MCOs due to the reason stated above, the patient can call the Medicaid hotline at (800) 324-8680, press “4” when prompted, and speak with a representative about switching plans. Their hours of operation are 7:00 am-8:00 pm Monday-Friday and 8:00 am-5:00 pm on Saturday
  • For legal reasons, a pharmacy can not tell the customer one specific managed care plan to change to that is in network for that pharmacy, but they can offer a list of managed care plans for which their pharmacy is currently participating in.  Don't let customer you know and love be forced into using a specific pharmacy or a network that may be miles away and much less attentive to their needs.  Help your customers fight for you.