Illinois State Rep. La Shawn K. Ford (9th) has introduced a bill to ensure that insurance companies that are part of the state’s Medicaid managed care program don’t restrict recipients’ access to certain pharmacies —an issue that’s especially acute in the neighborhoods that don’t have many pharmacies to begin with.
Under managed care, all Illinois Medicaid beneficiaries must choose a health plan offered by either an insurance company or, in the case of CountyCare, by the Cook County Health and Hospitals System.
While Ford’s bill would apply to every plan, he specifically cited what happened after CVS Health, the parent company of the CVS Pharmacy chain, acquired one of the providers — the Hartford, Conn. based Aetna — in 2019. Effective Dec. 1, 2020, Aetna stopped allowing beneficiaries of their plan to use Medicaid benefits in Walgreens, a CVS competitor.
Ford argued the move made it harder than ever for West Siders, many of whom already don’t have easy access to pharmacies, to get their medication. His bill would prohibit any other company from ever restricting pharmacy choices. While the bill was only filed on Feb. 3 and didn’t have co-sponsors as of Feb. 4, Ford said that he was confident that it would be passed by May.
Since 2018, all Medicaid recipients in Illinois have had to choose a health plan through the HealthChoice Illinois managed care program. The amount of plans have varied over the years, but starting this year, Cook County beneficiaries have five options to choose from. If they don’t choose a plan, the state will choose it for them. And while beneficiaries can change plans during the first 90 days of enrollment, after that, they can’t change a plan for a year.
According to CVS’s online store tracker, the chain has a location in Galewood, at 1819 N. Harlem Ave., but there are no other West Side locations. CVS’s East Garfield Park location, at 3146 W. Madison St., was one of the 11 locations closed throughout Chicago in 2017.
By contrast, Walgreens has four locations in Austin and one location in North Lawndale. The independent pharmacies, such as North Lawndale’s Del Mar Drugs, 3726 W. 16th Ave., are few and far between.
Ford said that he got multiple calls from his constituents and healthcare providers expressing concerns about the impact of Aetna’s decision. He said that last December he reached out to Gov. J.B. Pritzker and representatives with the Illinois Department of Healthcare and Family Services (HFS), which runs the managed care program.
Ford explained that managed care plans are required to allow their beneficiaries to get their subscriptions and buy medical supplies, but he said that, according to HFS, since beneficiaries can still use non-Walgreens pharmacies elsewhere in Cook County, they didn’t break the law.
“Limiting pharmacy options for Medicaid recipients affects people not only on the West and South Sides of Chicago, but people throughout Illinois,” Ford said. “During this COVID-19 pandemic, when people need their medications and the coronavirus vaccine at pharmacies and when people are dying daily due to opioid overdoses, it makes no sense to limit access to pharmacies.”
Ford’s bill would make the restrictions that Aetna imposed illegal and would require HFS to compile reports on how well managed care organizations serve beneficiaries in terms of pharmacy access. The law would be effective immediately once it’s signed.