CVS Suddenly Out of Network for Over 800,000 in NJ Health Plan

Effective April 30th, if you are insured through Horizon NJ Health, you will have to pay full price to get your prescriptions filled at CVS Pharmacy locations in New Jersey.

CVS will be considered an out-of-network pharmacy for Horizon NJ Health, a subsidiary of Horizon Blue Cross Blue Shield of New Jersey.

Horizon NJ Health serves more than 800,000 publicly insured children and adults in the Medicaid and NJ FamilyCare programs.

The change applies specifically to Horizon NJ Health (Medicaid/FamilyCare) members and does not affect commercial Horizon Blue Cross Blue Shield of New Jersey plans. 

CVS is Pulling Out of NJ RX Plan

The split results from contract disputes over reimbursement rates, with both sides citing unsustainable demands.

A Statement from CVS said they put forward a competitive proposal, but Horizon turned it down.

“CVS Pharmacy submitted a proposal that was equitable and competitive with other New Jersey Medicaid plans, but Horizon rejected it and demanded rates that are unsustainable for our pharmacy business.”

A spokesman for Horizon told NJ.com that CVS would not negotiate and "chose instead to leave our Medicaid pharmacy network.”

CVS is remaining in-network with the state’s other managed care health plans, including Aetna Better Health of New Jersey, Fidelis Care, UnitedHealthcare Community Plan, and Wellpoint.

What Members of Horizon NJ Health Should Do

Members of Horizon NJ Health will have to transfer prescriptions to a different in-network pharmacy before the deadline to avoid out-of-network costs. 

Members can use other in-network pharmacies, such as Walgreens or independent, locally-owned pharmacies.

With Rite Aid going out of business and fewer pharmacy options and locations, that's not as convenient as it once was.