(The Center Square) — Less than 3% of folks with prescription coverage through the state health insurance plan will be forced to find new pharmacies after 72 independent pharmacies opted out of a new pharmacy benefit manager network.
The finding comes from a Louisiana Legislative Auditor report issued last week aimed at gauging the impact of a new pharmacy benefit manager contract that took effect on Jan. 1. The new contract with CVS Caremark resulted in some independent pharmacies opting out of the network because the cost to obtain certain drugs exceeded reimbursements and lawmakers requested the LLA analyze what that will mean for Office of Group Benefits plan participants.
“Of the 199,419 OGB plan participants enrolled as of December 21, 2022, 5,167 (2.6%) only visited pharmacies in calendar year 2022 that opted out of the CVS Caremark network, meaning these plan participants will have to find new pharmacies to fill their prescriptions,” the report read. “Plan participants who use pharmacies in municipalities in rural parishes appear to be more affected by the pharmacy opt outs than members in more populated parishes.”
A total of 53 pharmacies opted out of both commercial and Employer Group Waiver Plan coverage, while 16 opted out of one or the other and three opted out of both. While no pharmacies opted out in larger municipalities like New Orleans, Lafayette, or Lake Charles, all pharmacies opted out in smaller municipalities like Cottonport and Mangham, auditors wrote.
“For example, the two in-network pharmacies in Cottonport filled 7,211 prescriptions for 568 OGB plan participants during calendar year 2022,” according to the report. “Of these 568 plan participants, 272 (47.9%) only used these two pharmacies and no others, meaning those individuals have to now find a new, in-network pharmacy.”
Auditors identified eight municipalities where all pharmacies fully opted out of the network: Cottonport, Mangham, Bentley, Ball, Basile, Campti, Folsom and Delcambre. One pharmacy in Erath opted out, but later opted back in on Jan. 13.
The eight opt out municipalities include 10 pharmacies that served about 1,060 plan participants in 2022 who only used those pharmacies. Those plan participants made a total of 27,750 visits to the opt-out pharmacies, including 14,159 visits from participants who only use the opt-out pharmacies.
Auditors noted that in three additional municipalities – Gray, Maurice and Pierre Part – the only pharmacy partially opted out.
The LLA report includes a breakdown of pharmacies and the numbers opting out for each parish, as well as a map of pharmacies by participation status for 2023.
The data shows East Baton Rouge, Evangeline and Terrebonne parishes had the highest number of opt-outs at six, followed by five opt-out pharmacies in Vermilion and St. Landry parishes. Jefferson, Lafourche, Rapides and Tangipahoa parishes each have four pharmacies that opted out.
In total, only 72 of 1,213 pharmacies opted out of the network. In 2022, 5,167 plan participants who only used those pharmacies made 68,422 visits, while total visits to those pharmacies by all 12,645 plan participants who used them numbered 152,815.