One of New Hampshire’s Medicaid plans no longer allows enrollees to fill their prescriptions at CVS Pharmacy locations, the state health department confirmed Thursday.
The Well Sense Health Plan — which covers tens of thousands of Granite Staters as one of three private health insurance plans offered through the state’s Medicaid program — switched to a new pharmacy benefits manager late last year, which CVS doesn’t participate with.
“It was not our choice to be removed from WellSense’s network,” CVS spokesman Michael DeAngelis said in an email, “and we’re ... disappointed that we can no longer serve their plan members.”
Medicaid, funded through state and federal governments, covers medical costs for people of low income and resources. Just over 214,000 New Hampshire residents were enrolled as of Jan. 31, more than 14,000 of them in Cheshire County, according to data from the N.H. Department of Health and Human Services.
While Medicaid is publicly funded, the coverage in New Hampshire is provided by private entities that contract with the state.
Recipients choose which plan to be on, the state’s website says, and all the plans cover the same types of service. However, they may have different provider networks, as well as various extra incentives and programs.
The Well Sense plan’s shift to the company Express Scripts — which doesn’t include CVS Pharmacy in its network — to manage prescription drug benefits has affected about 8,000 of the 92,000 Well Sense members statewide, according to Kathy Remillard, spokeswoman for the state health department. These people were notified of the change by Express Scripts in November and December.
“We selected Express Scripts (ESI) as Well Sense Health Plan’s Pharmacy Benefits Manager based on the strength of its experience, cost effectiveness, and quality of services ...,” Richard Wolosz, a Well Sense spokesman, said in an email. “As part of the transition to ESI, we implemented the ESI Advantage Network, which includes several major chains and independent pharmacies, but does not include CVS.”
There are three CVS locations in the Monadnock Region — two in Keene (one of which is inside Target) and another in Peterborough.
Eleven of Cheshire County’s 13 pharmacies are covered still for Well Sense Medicaid recipients, according to Wolosz.
Statewide, in addition to many independent pharmacies, those covered include Genoa, Hannaford, Price Chopper, Rite Aid, Sam’s Club, Walmart and Walgreens.