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Caremark: Centene WellCare Medicare Part D 2023



November 29, 2022

Effective Date: January 1, 2023

WellCare sent letters to patients indicating AlignRx member pharmacies will be out-of-network for these plans beginning January 1, 2023:

• WellCare Medicare Advantage Prescription Drug Plans (MA-PD) (Except for Louisiana, Michigan, Mississippi, and Missouri, where pharmacies will be in-network for WellCare Community Assist MA-PD)
• WellCare Prescription Drug Plans (PDP)
• HealthNet (Except for plans in the Standard Network 00 and Network 9 Extended Day Supply, where pharmacies will be in-network for HealthNet)

These out-of-network plans fall under the Caremark 2023 Medicare Part D Retail Centene Performance Network Program – Standard 2. Specific BIN/PCN/Groups impacted are below:

As a reminder, AlignRx declined PSAO participation in the Caremark 2023 Medicare Part D Retail Centene Performance Network Program – Standard 2 due to the proposed reimbursement rates.

The network rates offered were very aggressive, and the DIR withhold rate was excessive. If AlignRx had signed this contract, your pharmacy would lose, on average, $2.93 per script. Further, the DIR withhold rate, off ingredient cost paid, is between 15% and 17% for brand drugs and 39% to 41% for generic drugs—yielding an average DIR withhold of $26.83 per script.

NOTE: Caremark informed AlignRx that pharmacies will not be able to sign a direct contract for the Centene WellCare and Health Net plans in 2023.

Thank you,

AlignRx, LLC 

This message is confidential and proprietary. Do not distribute.

QUESTIONS?

Contact AlignRx Pharmacy Services at 844-ALIGNRX (844-254-4679), option 1.