When patients lose Medicaid coverage, oftentimes they don’t find out until they’re at their pharmacy trying to refill a prescription. About 65% of Medicaid enrollees are unsure if states can disenroll people from Medicaid if they aren’t eligible or didn’t renew coverage. Walgreens Boots Alliance is combatting this through education and patient navigation, company leaders said during the AHIP 2023 conference in Portland, Oregon.

Medicaid redetermination is the process used by states to determine if enrollees are still eligible for Medicaid. Redeterminations were put on hold during the Covid-19 public health emergency, but resumed April 1. 

Deerfield, Illinois-based Walgreens already helps patients during the open enrollment period, but had to be extra prepared for Medicaid redeterminations, said Rina Shah, senior vice president of pharmacy of the future and transformation at Walgreens. 

“We knew we had to double down on that and be able to support that,” Shah said during an interview.

However, each state is conducting redeterminations differently and on a different timeline. So far, more than 1.2 million Medicaid enrollees have been disenrolled, with rates varying drastically by state, according to KFF. About 76% of those disenrolled were removed from coverage for procedural reasons, such as not completing the renewal process, the same report showed.

“Every state is different,” Shah said. “And so what you can do in Florida is very different [from] what you do in, say, Illinois. Then the timing is also very different. So we’ve been working closely with our government affairs team to understand the timing of when everything was going to be activated.”

Walgreens also has a website to help patients understand the redetermination process, Shah said. If an issue occurs while a patient is trying to refill a prescription, the staff is trained to provide guidance, she added.

“Unfortunately, we’re not the ones that are able to process the paperwork for them or anything of the sort, but we can at least navigate them to the appropriate advocate so that they can help them through that,” Shah said.

Roz Brewer, CEO of Walgreens Boots Alliance, echoed Shah’s comments during a session at the conference.

“We have to sit with Medicaid and understand what’s next,” Brewer said. “Our team does a lot of work in that space so that we can be that first responder when these questions surface because it happens right in our stores. The insurance will change or drop and we need to know how that happened. I think people underestimate the work of a pharmacist and their team. They think that they’re just counting pills and putting them in jars. It is a critical job.”

Brewer noted that oftentimes, patients are receiving 90-day supplies of their medications. The company will reach out ahead of time if it notices a change in insurance. It’s also working to support patients experiencing a gap in coverage during the redetermination process, she added.

“One of the things we’re trying to do to aid indirectly in this is to provide our pharmacists the ability to test and treat in stores so that when this insurance piece gets upside down and not understood, they still have someone that can care and deliver for them in that timeframe,” Brewer said. “Now that takes a little bit of work to do that, but we are definitely on the end of educating and partnering with Medicaid to make sure that [in that] little gap [of] time, the patients aren’t missing their medications.”

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