Delays impacting operations, including payments and insurance transactions

Earlier this month, one of the nation’s largest health care companies experienced a cybersecurity attack immobilizing much of the industry. Change Healthcare, a subsidiary of UnitedHealth Group that also operates as Optum Solutions, states that it interacts with 1 in every 3 patient records. Their systems are integral in many areas of pharmacy operations, provider claim processing, billing and cost estimation services, patient eligibility verifications, and other clinical decision supports.

On February 21, 2024, Change Healthcare locked their systems in an attempt to limit the impact of the cybersecurity attack discovered that day. The ongoing disruption has created adverse impacts for providers and pharmacies, generating delays for consumers, limiting the ability to process payments and consumers’ insurance, and requiring complex workarounds or movement to new systems. It is believed that the attack was completed by a foreign hacking group. Federal entities are involved in the investigation.

“The implications of this cyberattack are wide-reaching and not yet fully known. We hope that raising awareness of this issue will encourage consumers to be patient with any delays in clinical and pharmacy activities. Please know that all parties are working as hard as they can to continue operations despite this issue. If you are in urgent need of medication, or will be soon, please get in touch with your local pharmacy before visiting. You may need to use a different pharmacy, or plan to pay in cash,” said Insurance Commissioner Trinidad Navarro. “No timeline currently exists for resolution, and health care providers and pharmacies have been encouraged to remain disconnected from the impacted systems.”

Insurers have been in contact with the Delaware Department of Insurance about this issue and are in communication with contracted providers to inform them of available portals and processes. The Delaware Insurance Data Security Act has not yet been triggered, but all parties continue to watch the situation closely. Additionally, the department will be closely monitoring any potential prompt payment compliance issues that may arise as a result of this situation.

At this time, there is no indication that consumer data or insurer data has been impacted. However, consumers are still encouraged to engage in personal cybersecurity practices at an enhanced level. To protect from a cybersecurity attack, install anti-malware protection and use complex passwords that cannot be easily guessed. Do not click on suspicious links in emails or pop-ups, including those purporting to be from health care services, providers, insurers, and pharmacies. Residents might consider freezing their credit report to protect data.

View Change Healthcare’s Incident Page

Agency Also Kicks off Marketing Campaign to Encourage Seniors, Individuals with Disabilities to Get Vaccinated

WILMINGTON (Dec. 14, 2021) – The Department of Health and Social Services (DHSS) today announced a new toll-free number for Delawareans to request COVID-19 vaccinations for eligible seniors and people with disabilities who cannot access a vaccination location because of disability, age or severe illness. DHSS also kicked off a marketing campaign aimed at supporting seniors and individuals with disabilities to get answers to questions they have about the vaccine and boosters.

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In the Homebound Vaccination Program, DHSS is partnering with independent pharmacies in each county to deliver the vaccinations to eligible Delawareans 5 and older. Lt. Governor Bethany Hall-Long, DHSS Secretary Molly Magarik and others announced the new vaccination program during an event Tuesday at one of the independent pharmacies, Ivira Pharmacy in Wilmington. Other participating pharmacies are Ivira Pharmacy’s location in Milford, Camden Pharmacy, Seaford Pharmacy, and Express Pharmacy in Laurel.

“Nothing is more important than getting more Delawareans vaccinated,” Lt. Governor Bethany Hall-Long said. “As a state, we are committed to removing as many barriers to access as possible. A toll-free line that older Delawareans and others who are homebound can call to be assessed for an at-home vaccination is an important step. So, too, is a new marketing campaign featuring older Delawareans, caregivers and individuals with disabilities.”

Starting Dec. 15, all requests for a homebound vaccination or booster will be filtered through a toll-free number – 1-888-491-4988 – to be assessed and scheduled. Live operators will staff the toll-free line from 8 a.m. to 8 p.m. Monday through Friday, and 8:30 a.m. to 6 p.m. Saturdays. To learn more, visit DHSS’ website at VaccineAccessDE.com.

“One of the many lessons we’ve learned during the 21 months of this pandemic is that we have to meet communities where they are,” DHSS Secretary Molly Magarik said. “Today’s announcement is about meeting seniors, individuals with disabilities, their families and caregivers where they are. It’s about supporting them in getting access to the COVID-19 vaccine and boosters, and it’s about ensuring that we can answer the unique questions that seniors and people with disabilities have about the vaccine.”

Earlier this year, in the first phase of its Homebound Vaccination Program, community nurses with DHSS’ Division of Public Health and Division of Services for Aging and Adults with Physical Disabilities, along with contract nurses with the Division of Developmental Disabilities Services, worked with community partners, including DART Paratransit, to identify and vaccinate more than 500 Delawareans who are homebound.

In connection with this new phase, DHSS is launching a marketing campaign aimed at encouraging individuals with disabilities, their families and seniors to call the Division of Public Health at 1-833-643-1715 if they have questions about the COVID-19 vaccine or to visit DHSS’ webpage for information and resources at VaccineAccessDE.com. As part of the campaign, seniors, individuals with disabilities and their family members talked about what getting the COVID-19 vaccine has meant to them. The campaign is funded through grants from the U.S. Administration for Community Living.

“It is important for us to launch this campaign that specifically addresses the questions and concerns that older Delawareans and individuals with disabilities and their families may have,” said Melissa Smith, Director of DHSS’ Division of Services for Aging and Adults with Physical Disabilities. “We are excited because it features Delawareans telling their own stories in print and video messages in order to help others feel comfortable about reaching out with questions and any accommodations they might need to get the vaccine.”

The Centers for Disease Control and Prevention (CDC) has found that people with disabilities and seniors are at high risk for serious illness, hospitalization and death from COVID-19. In Delaware, about 80% of the 2,218 people who have died from COVID-19 were 65 or older.

To help protect people in vulnerable groups, it’s important that everyone get vaccinated, practice social distancing, wear face masks indoors in public, get tested as needed, and wash their hands. In Delaware, almost 63% of all Delawareans are fully vaccinated, including more than 91% of those age 65 or older. But only 55% of seniors 65 or older have gotten their boosters.

While Delaware does not have data on the percentage of people with disabilities who are vaccinated, about 79% of American adults with disabilities have reported receiving at least one dose of the COVID-19 vaccine, compared with 84% of adults without a disability, according to a U.S. Census Household Pulse Survey. The Census Bureau survey, which was conducted among more than 100,000 adults in two phases from June to August of this year, found that the disparities among individuals with disabilities persisted across all age groups, in most race and ethnicity categories, and across all types of disability, even though adults with a disability reported less hesitancy to getting vaccinated.

A CDC study, published in October, found that adults with a disability anticipate or experience more difficulty getting COVID-19 vaccinations than adults without a disability. To help improve vaccination rates, the CDC recommended reducing barriers to vaccination scheduling and making vaccination sites more accessible.

Department of Insurance will lead effort to rein in monopolistic behavior and excessive pharmaceutical costs

Insurance Commissioner Trinidad Navarro announced today that the Delaware Department of Insurance will begin the process of building and enforcing regulations regarding Pharmacy Benefit Managers (PBMs) as a new law goes into effect. The new authorities of the department will ensure consumer access to affordable medications and protect local pharmacies from the predatory behaviors exhibited by the PBM industry through measures of transparency and corporate accountability.

“Alongside members of the General Assembly, advocates, pharmacy representatives, and industry stakeholders, we have been working towards this goal for years. We have heard the voices of those who have had to travel hundreds of miles for their children’s medications. We have heard the plight of the local pharmacies, the way they have been financially devastated by PBM’s preference of their own chains. We have watched as other states were taken advantage of by these companies and cheered those states on as they took action to stop predatory practices. We have seen partners in this fight retaliated against by these companies, and we mourned as more and more neighborhood pharmacies had to close their doors,” said Insurance Commissioner Trinidad Navarro, referencing the work of the Pharmacy Reimbursement Task Force and other legislative initiatives and discussions. “Now, with these new powers, we say ‘No more.’”

HB 219, sponsored by Rep. Andria Bennett, Sen. Spiros Mantzavinos, Senate President Pro Tempore David Sokola, and Rep. Mike Smith, was passed by the General Assembly unanimously and recently became law, bringing Delaware’s oversight of the multi-billion-dollar industry on par with leading states.

PBMs act as intermediaries for prescription drug plans, influencing what medications will be covered and the costs of those drugs for both consumers and pharmacies. These companies bring in billions through manufacturer rebates, limiting generic drug offerings, and retaining negotiated savings, while costs for consumers continue to rise. The largest PBMs operate their own pharmacy chains, and their consolidated market power has, prior to this law, allowed them to pay unaffiliated pharmacies unsustainably low reimbursement rates – rates lower than it costs the pharmacy to dispense the drug to a consumer. PBMs’ move toward monopolization has contributed to waves of independent pharmacy closures across the nation, especially in rural, inner city, and under-served areas that already crave equity and access.

“I have worked on this issue for years and have seen firsthand how pharmacy benefit managers’ predatory practices have increased consumer costs while decreasing consumer access and driving out small, unaffiliated pharmacies. With healthcare cost emphasized throughout the pandemic, it is more important than ever to have these protections in place,” said Rep. Andria Bennett, the prime sponsor of HB 219 and chair of the Pharmacy Reimbursement Task Force. “This new law passed the General Assembly unanimously, and it did so because there are two things we all agree on: that the cost of prescription drugs is far too high, and that billionaire corporations should not be above the law.”

The new law aims to solve many issues of access and inequal treatment through use of the National Average Drug Acquisition Cost for pharmacy reimbursement, prohibiting inequal payments to unaffiliated pharmacies, and providing the Department of Insurance the ability to investigate PBMs, enforce consumer protection measures, and incentivize corrections through increased regulatory authority. In order to better understand PBM’s existing processes, the department recently began introductory Market Conduct exams on registered PBMs, known to be the first investigations of this kind in the nation. These initial examinations will not result in fines or enforcement actions, but will highlight areas for improvement, including those that are not compliant with the new law, and will require corrective action plans.

Rep. Mike Smith – a prime sponsor of HB 219 – stated, “This is an exciting moment for Delaware. This was a collaborative effort to support Delaware’s small, independent pharmacies and all Delawareans. At the end of the day, consumer protection won, and I’m proud of the work we did to bring accountability to PBMs.”

“Reducing prescription drug prices will directly improve the health and welfare of our neighbors,” said Sen. Spiros Mantzavinos, Senate prime sponsor of HB 219. “This new law will provide for greater oversight of the pharmacy benefit manager industry, allowing for more consistent prescription drug prices and ensuring expanded access to the medications Delawareans rely on. I am proud to have helped champion HB 219 alongside Rep. Bennett and look forward to Delawareans reaping the benefits of this expanded oversight.”

While independent pharmacies faced retaliation from the multi-billion-dollar giants, including through costly audits, they continued to advocate for change. Now, they are celebrating the new law and the protections it holds for their customers.

“The true beneficiaries of this new PBM oversight will be the patients. They have always deserved health care that is accessible, affordable and transparent – not barriers to care, higher costs and excuses while PBMs lined their pockets. Having the Delaware Insurance Commissioner’s office oversee PBMs will greatly assist underserved and vulnerable populations who struggle to afford their medications, and who have experienced barriers to patient care,” explained Kevin Musto, R.Ph., FAPhA, an independent pharmacist.

The Delaware Pharmacy Society also shared their enthusiasm for the new law. “We are tremendously delighted with enactment of HB 219, which increases transparency and equity in pharmacy benefit management. It is our belief that this law will result in increased access to health benefits for Delawareans, provided at the most accessible health care providers – pharmacies. This law makes Delaware a pioneer in controlling health care costs,” they stated.

In the coming months, the Department of Insurance will draft relevant regulations, receiving input from stakeholders during that process. After draft regulations are developed, they will be published, and the public will have 30 days to comment.

Expanded oversight of Pharmacy Benefits Managers possible

Legislation to further regulate the Pharmacy Benefits Manager industry was passed by the General Assembly in late June and sent to the Governor with unanimous bipartisan support.

HB 219, sponsored by Rep. Andria Bennett, Sen. Spiros Mantzavinos, Senate President Pro Tempore Dave Sokola, and Rep. Mike Smith, would bring Delaware’s oversight of the multi-billion-dollar industry on par with other states. Insurance Commissioner Trinidad Navarro and the Delaware Department of Insurance were proud to work with the sponsors on this bill and share their goals of ensuring access to affordable pharmaceuticals and protecting local pharmacies.

A Pharmacy Benefits Manager (PBM) acts as an intermediary for prescription drug plans, influencing what pharmaceuticals will be covered, and the consumer and pharmacy costs of those drugs. These companies hold massive power and bring in billions through manufacturer rebates, limiting generic drug offerings, and retaining negotiated savings while costs for consumers continue to rise. The largest PBMs operate their own pharmacy chains, and their consolidated market power allows them to pay unaffiliated pharmacies unsustainably low reimbursement rates – rates lower than it costs the pharmacy to dispense the drug to a consumer. PBMs’ move toward monopolization has contributed to waves of pharmacy closures across the nation, especially in rural, inner city, and under-served areas – areas that already crave equity and access.

HB 219 aims to solve many of these issues through efforts such as required use of the National Average Drug Acquisition Cost for pharmacy reimbursement, prohibiting inequal payments to unaffiliated pharmacies, and providing the Department of Insurance the ability to investigate PBMs, enforce consumer protection measures, and incentivize corrections through increased regulatory authority.

“With more consumers and local pharmacies facing dire financial situations, and more PBM wrongdoing coming to light, we must act with urgency in reining in this industry. In a developed nation, it is unconscionable that a mother would have to go hundreds of miles to get her child’s medication affordably, and no pharmacy should have to fight for months on end for the right to provide their clients needed pharmaceuticals without going bankrupt,” said Insurance Commissioner Trinidad Navarro, referencing passionate resident testimony provided at the bill’s legislative committee hearings.

“We need the authority to enforce consumer protections, to require price transparency and cost containment, and to ensure that these big corporations can’t exclude the small businesses and local pharmacies that have served our community for decades. I’m so thankful for the sponsors of HB 219 for working so hard on this needed legislation, and I am grateful that every single member of the General Assembly supported the effort.”

“For too long, pharmacy benefit managers’ egregious predatory practices have put profits above consumers. With this legislation, we are implementing critical reforms that will improve the oversight of this murky industry and ensure everyday Delawareans are not taken advantage of in such a vulnerable way,” shared Rep. Andria Bennett, the prime sponsor of HB 219 and chair of the Pharmacy Reimbursement Task Force. “I’m grateful for the outpouring of support this legislation has received both in the General Assembly and from individuals and small businesses throughout our state. We owe it to residents to fight for their best interests by increasing affordability and access to needed medication. That’s exactly what we’re doing with HB 219.”

“I served alongside Rep. Bennett on the Pharmacy Reimbursement Task Force and have seen firsthand how the middlemen between drug makers and pharmacies can drive up costs for consumers and even threaten the financial viability of independent pharmacies throughout our state,” said Senate President Pro Tempore Dave Sokola. “HB 219 will give Delaware the tools it needs to properly regulate this industry to ensure we’re controlling the costs of life-saving medication and protect the pharmacies who serve them.”

Rep. Mike Smith stated, “I was proud to co-sponsor this measure and help shepherd it through the House. This is ultimately a consumer protection bill with the intended goal of ensuring citizens have affordable access to prescription drugs. It is my hope that the Governor will sign this legislation without further delay.”

“Reducing prescription drug prices is one of the most important things we can do to help improve the health and welfare of our neighbors,” said Sen. Spiros Mantzavinos, the Senate prime sponsor of HB 219. “I am proud to have helped champion this legislation that will provide greater oversight of pharmacy benefit managers, a little-known industry that has a huge impact on whether you can get the medication you need and at what cost. I want to thank Rep. Bennett for her hard work on this legislation and I look forward to it being signed into law soon.”

The legislative effort was supported by consumers and independent pharmacists throughout the state, and the Delaware Pharmacist Society, who spoke passionately about the need to regulate PBMs.

“Not only have PBMs failed to manage the cost of prescription medications, which is the reason they were created, but they have artificially inflated medication prices, causing patients to struggle to afford their medication, while they continue to line their pockets. And, while Independent pharmacy strives to find ways to assist patients with chronic diseases, those who are underserved and vulnerable populations, PBMs put profits over patient care and have created barriers for patients to utilize our services, while forcing them to utilize more cumbersome and costly options,” explained Kevin Musto, R.Ph., FAPhA, Independent pharmacist.

“The Delaware Pharmacist Society is elated that patients as well as pharmacists may soon be able to appeal inadequate prescription drug reimbursement, and that unregulated PBMs would have to answer to the Insurance Commissioner’s office on their business practices,” said Dr. Kim Robbins, Executive Director of the Delaware Pharmacist Society. “Pharmacists have tried to fight PBMs individually and have been unsuccessful. PBM reform will allow the Insurance Commissioner’s office to protect consumers.”

DOVER, DE – All Delaware prescribers and pharmacists can now integrate their electronic health record and pharmacy management systems with the state’s prescription monitoring program (PMP), the Delaware Division of Professional Regulation has announced.

The integration will be via Appriss Health’s PMP Gateway solution.

Appriss Health has delivered PMP services for the Delaware Division of Professional Regulation since 2017. The system manages more than 16 million controlled substance prescriptions and currently has more than 7,800 users.

The Delaware Division of Professional Regulation is covering all fees associated with the integration service to ensure broad adoption and help providers meet state mandates and policies regarding the prescribing of controlled substances.

“Delaware currently has the second highest drug overdose death rate in the United States, and the ongoing opioid crisis has created a colossal challenge for the state’s behavioral health treatment providers,” Delaware Prescription Monitoring Program Administrator Jason Slavoski said. “This statewide partnership with Appriss Health improves our PMP’s efficacy to help mitigate the opioid epidemic in our communities.

Through PMP Gateway, all providers throughout the state will have easier access to new resources and PMP information within their clinical workflow. This integration helps to enhance timely clinical support decisions and improve patient care and safety for all Delaware residents.

The statewide integration of PMP data into electronic health records (EHR) at the point of care increases the ease of access and use of prescription information to help healthcare providers make critical clinical decisions, including the prescribing and dispensing of controlled substances, as well as patient care and safety.

Prior to this integration initiative, Delaware prescribers had to log in to separate systems to query patient information, which took important time away from patient care. Now, the EHR will automatically initiate a patient query, which will return the patient’s controlled substance prescription records directly within the clinical workflow inside the EHR.

“Wide adoption of prescription monitoring information into clinical workflow can effectively identify, prevent, and manage potential problems with prescription drug addiction,” said Appriss Health President Rob Cohen. “We’re honored to partner with the Delaware Division of Professional Regulation to provide healthcare providers with enhanced tools for early intervention of substance use disorder and improved outcomes.”

Media Contact:
Michael Chesney
Delaware Department of State
302-577-8472
michael.chesney@delaware.gov