Stay up-to-date regarding the Change Healthcare outages, Prime/MRx’s response and find answers to FAQs. Check out the latest updates.

We will continue to update this page as more information becomes available. Last updated April 19, 2024, 11:30 a.m. CT.

Please be advised, at approximately 8 a.m. Central Time (CT) on Feb. 21,2024, Prime observed a drop in claim volume from Change HealthCare (CHC). Prime has learned CHC is experiencing a national IT system outage as a result of a potential cyber security issue. Prime first communicated this issue Feb. 22, 2024.

Impact 
Due to this national outage, retail pharmacies that have elected to use CHC may be experiencing issues with flowing claims to Pharmacy Benefit Managers (PBM). As such, any claims routed through CHC are not being received by Prime and members may experience errors trying to process a claim.

Please see below for updates.

Updated April 19, 2024, 11:30 a.m. CT

Impacted pharmacies update 
As previously shared, Prime/Magellan Rx (MRx) has been partnering with our retail community as they transition to alternative switch vendors to restore their claim traffic. We have positive updates to share on the remaining two pharmacy chains on Prime/MRx’s watch list (Department of Veteran Affairs and Indian Health).

CHC has partnered with RelayHealth and these pharmacy chains to transition claim traffic. CHC has confirmed the connectivity setup of that transition is now complete. Chains are now in the process of transitioning each of their respective locations to RelayHealth’s process, which is expected to be completed by the end of next week. Prime has already started to see claim traffic flowing through some of those locations. We will continue to monitor progress as we partner to close out the remaining watch list pharmacies.

Prime’s response in the event of compromised data
Prime/MRx has conducted a thorough analysis to understand the business relationships we currently have with CHC, reviewed the data flows and conducted a contract review.

At this time, CHC has not reported any compromised data, however, we continue to monitor updates from CHC. In the event CHC confirms data was breached, we have determined that we would not expect CHC to notify Prime/MRx. We are not contracted directly with CHC to provide clearinghouse services. Below is a chart to summarize CHC reporting obligations.

Business Use:	Does Prime Interact with CHC?	Who holds contract with CHC?	Who CHC would notify of Breach?
Claims Recovery Services/Subrogation MRx PBM Business	No	N/A	N/A
Claims Recovery Services/Subrogation Prime PBM Business	Yes	State Medicaid Agencies and MCOs, who are CHC’s Customers	State Medicaid Agencies and MCOs
Pharmacy Switch Prime and MRx PBM Business	Yes	Pharmacies, who are CHC’s Customers	Pharmacies ​​​​​
Pharmacy Switch MRx/VRx Mail Order and Specialty Pharmacies	Yes	Prime/MRx’s vendor	MRx/Prime’s vendor, who would notify Prime/MRx.  Prime/MRx would notify affected patients * MRx Clients would not be named in any notification.

CHC primarily serves as a switch that routes claims from the pharmacy to the plan/payer or PBM. CHC is considered a health care clearinghouse as defined as an organization that processes or facilitates the processing of healthcare data between the provider and payer.

Under HIPAA, a clearinghouse is a Covered Entity, and subject to the HIPAA Privacy, Security, and Breach Notification Rules. With this designation, CHC would be required to notify the affected individuals, federal and state regulators and the media where required.

Updated March 20, 2024, 9 a.m. CT

Pharmacy Switch Restoration Update
CHC recently announced they restored functionality to pharmacy switch vendor services. While functionality has been restored, additional work is underway with CHC to fully restore claim volume traffic at each remaining pharmacy chain.

CHC has created a workaround whereby pharmacy claims that are submitted to CHC will be rerouted to RelayHealth to provide claim switching services on behalf of CHC. This workaround has enabled a functional process that does not utilize CHC’s existing systems in the interim.

CHC is working with each pharmacy chain that was previously unable to convert to another switch vendor to connect to this new functional workaround process. While most pharmacy chains have restored their pharmacy claim traffic, Prime/MRx has provided a list of remaining impacted pharmacies for CHC’s prioritization. We expect to see continued movement from CHC to restore claim traffic for the remaining pharmacies.

U.S. Department of Health and Human Services (HHS) Memos
Prime/MRx has been engaged with HHS and other partners throughout the CHC cybersecurity event. HHS has requested the healthcare industry search for flexibility in various aspects to support impacted providers. CHC has communicated on their website various steps they have taken to provide financial and workaround assistance to the healthcare industry.

Currently, most of the healthcare industry’s impact remains on medical/hospital providers, as pharmacies have restored the majority of claim traffic. Prime/MRx has seen claim traffic normalize to expected daily levels, as pharmacies transitioned to other vendors and members shifted to other pharmacies. Prime/MRx has also seen the pharmacy community submit higher volumes in early March to catch up on previously dispensed orders during their outage to be reimbursed through our normal claim payment cycles. ​​​​​​

At this time, Prime/MRx has seen financial processes organically flow funds to our pharmacy partners and have not seen payment escalations warranting additional intervention. Prime/MRx remains focused on any escalation from pharmacies regarding payment or CHC impacts in order to partner with them through a given issue. 

Given that positive momentum, Prime/MRx is primarily focused on working with CHC to influence restoration for the remaining pharmacy chains to fully restore their claim switching services.

Updated March 5, 2024, 5 p.m. CT

Prime continues to meet with CHC daily to align on next steps. Currently, CHC does not have an estimated date of restoration.

Specialty and home delivery update
Our MRx Mail Order pharmacy and MRx Specialty Pharmacy have completed their transition to RelayHealth and have returned to normal claims processing. Claims not submitted during the outage from last week will be submitted by MRx specialty pharmacy this week.

Please note that during the time of CHC’s outage, MRx Specialty Pharmacy was still able to continue dispensing medications to patients.

Updated Feb. 28, 2024 5 p.m. CT

Will account teams be provided list of impacted pharmacies to share with clients? 

Clients requesting similar impact analysis should send that request to Rui Mendes, Chris Romano and Jeff Young. 

Updated Feb. 27, 2024, 4 p.m. CT

Impacted pharmacies 

Prime/MRx continues to work with the pharmacy community to understand current pharmacy impacts. Pharmacies impacted most have implemented standard procedures to “take care of members,” meaning they will fulfill orders for existing patients by looking at history and dispensing in good faith – with the intent to bill later once claim processing is restored. Some pharmacies are working in parallel to add alternative switching companies. 

Prime/MRx has also seen material movement in the pharmacy community as they transition to alternative claim switching vendors. Over the last few days, we have seen the pharmacy claim traffic increase above normal volumes, indicating that the pharmacy community has begun formally working through claim processing backlog. 

Prime continues to meet with CHC daily to align on next steps. Currently, CHC does not have an estimated date of restoration. We will keep you posted as information becomes available. 

Specialty and mail order update
As previously communicated, the MRx specialty and home delivery pharmacies have had challenges processing claims because of CHC’s outage. During this time, we have been able to dispense medications to ensure members’ therapies are not interrupted through workaround processes. We are happy to report that as of last night our MRx Mail Order pharmacy has been fully restored to return to normal claims processing. MRx specialty pharmacy is expected to reach restoration by the end of this week as we complete the transition to a new switch vendor.  

Pharmacy communication update  
We have shared an updated pharmacy fax blast indicating we are aware participating pharmacies may still be experiencing unexpected claim rejections. We continue to influence them to transition to alternate switch vendors to restore claim processing until the outage is resolved. Those pharmacies were also advised they should continue to contact our Contact Center prior to dispensing any new medications to validate benefit coverage. Prime/MRx cannot guarantee payment for medications where participating pharmacies have not received a paid claim.  

Updated Feb. 22, 2024, 5 p.m. CT

Q: Who is Change HealthCare (CHC) and how do they impact claims? 

A: CHC is one of various switch vendors who contract with external pharmacies to receive claims from pharmacies and then forwards those claims to the appropriate adjudication PBM, such as Prime. Prime receives claims from multiple switch vendors with the majority going through CHC and RelayHealth.

Q: What updates have we learned from CHC regarding their reported cyber security incident? 

A: Prime debriefed with CHC and they confirmed they had a cyber security issue and are working to contain the threat and are doing impact analysis. There is no timing on when that process will be complete, and we will share updates as we receive them.

Q: What actions has Prime taken? 

A: Prime has mobilized a command center around this issue to coordinate efforts, problem solve member disruption and centralize feedback from our various pharmacy, provider, and client stakeholders. Some more specific actions are as follows:

• Prime has proactively shut down our connectivity with CHC as a precautionary measure. As CHC returns to normal operations Prime will need to understand how the threat was contained to ensure the vulnerability does not spread into our systems.
• Prime has been heavily engaged with our retail pharmacy community to understand their fallback plans and how they’re managing critical member disruption. Initially we have seen a few different actions begin:
  • Pharmacies with a secondary switch vendor in place, have begun to migrate volume to restore adjudication services.
  • Other pharmacies are working on implementing processes to provide short term emergency fill supply to critical patient needs.
  • Prime has instructed impacted pharmacies to direct disrupted members to big chain pharmacies as they currently have the most reliable transactional path.
  • Based on self-reported pharmacy data, Prime has identified approximately 2,500 pharmacies that appear to utilize CHC exclusively.
• Prime is conducting a data analysis to identify pharmacies that are no longer able to submit claims due to this issue, so we can partner with those pharmacies and our clients on how best to alleviate member disruption.

Q: Is there a confirmed data breach of Prime, client, or member data? 

A: CHC has informed Prime that at this time they are not aware of any of our information being impacted. CHC is conducting a forensic review of their system, as that process evolves, they will notify Prime if any such data is at risk. If Prime is informed of any data breach or privacy issue, our privacy team will promptly follow all applicable privacy protocols.

Q: Is mail or specialty order impacted? 

A: Prime has confirmed that mail order is currently impacted.  Our mail order service provider is actively working to transition to RelayHealth to mitigate the claim traffic.  Prime continues to process the intake of mail order scripts to queue the work once claim transactions have been restored.  Specialty services are currently not impacted.

Q: How does this impact members?  

A: Members at pharmacies that only connect through CHC are not able to have their claim adjudicated and covered by insurance, as the pharmacy is unable to send the transaction to any PBM. Members can have their prescription transferred to another pharmacy that is not impacted or pay out of pocket and submit a direct claim for reimbursement. Please be advised Prime is actively reaching out to suspected pharmacies that may exclusively use CHC to better understand what plans they have to mitigate member impact.

Q: What communication has been provided to pharmacies? 

A: We have shared an updated pharmacy fax blast clarifying that Prime’s systems are not down and have advised pharmacies to submit via another switch vendor if they have that option.

We will provide more updates as we learn more information.