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Change Health Care Updates: Coupons, Copays, and Temporary Payment Advance

As of April 2, the remaining three Fee-for-Service (FFS) Medicaid states went live between Sunday and Friday of last week. All six of the impacted Medicaid FFS states, including Iowa, are now back online and claims are flowing. Optum Rx reports continued progress related to coupons/copay programs. 

As of April 2, the remaining three Fee-for-Service (FFS) Medicaid states went live between Sunday and Friday of last week. All six of the impacted Medicaid FFS states, including Iowa, are now back online and claims are flowing. Optum Rx reports continued progress related to coupons/copay programs. 

In response to the Change Health Care outage, Optum has created a limited-duration cash advance process to support independent pharmacies in the Optum Rx Network. Network pharmacies may request an advance payment of funds based on prescriptions they have filled and provided to Optum Rx members where the pharmacy is experiencing cash flow problems due to dispensing those prescriptions. Pharmacies seeking a payment advance must request it through the Optum Rx Pharmacy Help Desk at 1-800-788-7871. 

As of March 28, Iowa Medicaid reports that pharmacy claims have begun processing again. Providers and pharmacies may contact the help desk for assistance in claims processing at 1-877-463-7671 or 515-256-4608 (local). 

For some medications, Change has rebuilt the coupon programs on the Rx Claims platform. There are currently more than 120 medications live on Rx Claim that pharmacies can now process with the same BIN/PCN as before. If pharmacies experience any issues, the Optum Rx Pharmacy Help Desk can assist them with troubleshooting. They are continuing to add new medications to the Rx Claim platform every day and anticipate addressing the remaining medications in the queue within the next two weeks. 

There is a subset of medications that have moved to other coupon/copay card processors and have new BIN/PCNs. If a pharmacy is having issues processing a copay card/coupon, they can check the Change Healthcare Copay Coupon Savings Program Update. This site includes a list of new BIN/PCNs for coupon/copay cards that have moved to other processors, as well as pharmacy help desk contact information (if available).


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