Pharmacy Claims Disruptions

UPDATE: 3/1/2024 – 2:30 PM

Good afternoon GatorCare members,

We wish to inform you of a temporary disruption at pharmacies throughout the country. This disruption is the result of a Change HealthCare cybersecurity issue resulting in significant network interruption. Prime (Magellan Rx) has provided no indication of any breach of personal data. This disruption should not impact access to medications.

Prime (Magellan Rx) is continuing to identify workarounds for the systems that have currently been discontinued until the vendor tools are confirmed safe and secure. In the meantime, please feel free to reach out to the Prime (Magellan Rx) customer support team for any assistance should you experience any difficulties with claims or payment.

GatorCare dedicated Magellan Rx customer support: 800-651-8921

Thank you for your understanding and patience. Check back here for current updates.


Q: Who is Change HealthCare (CHC) and how do they impact claims? 

A: CHC is one of various switch vendors who contract with external pharmacies to receive claims from pharmacies and then forwards those claims to the appropriate adjudication PBM, such as Prime. Prime receives claims from multiple switch vendors with the majority going through CHC and RelayHealth. CHC also supports flowing transactional claim data to our MedsYourWay program.

Due to this national outage, retail pharmacies that have elected to use CHC may be experiencing issues with flowing claims to Pharmacy Benefit Managers (PBM). As such, any claims routed through CHC are not being received by Prime and members may experience errors trying to process a claim.

Q: How does this impact members? 

A: Members at pharmacies that only connect through CHC are not able to have their claim adjudicated and covered by insurance, as the pharmacy is unable to send the transaction to any PBM. Members can have their prescription transferred to another pharmacy that is not impacted or pay out of pocket and submit a direct claim for reimbursement. Please be advised Prime is actively reaching out to suspected pharmacies that may exclusively use CHC to better understand what plans they have to mitigate member impact.

Q: What actions has Prime taken? 

A: Prime has mobilized a command center around this issue to coordinate efforts, problem solve member disruption and centralize feedback from our various pharmacy, provider, and client stakeholders. Some more specific actions are as follows:

  • Prime identified an opportunity to re-direct a material number of claims away from CHC and over to a different switch vendor. These changes were completed yesterday evening and resulted in restoration of ~95% of our regular claim volume. This activity continues to be monitored, as of today we have seen steady traffic flow continuing from these changes. The remaining volume are pharmacies in the process of moving to other switch vendors, or that only have connectivity with CHC and will need to pursue alternative approaches.
  • Prime has proactively shut down our connectivity with CHC as a precautionary measure. As CHC returns to normal operations Prime will need to understand how the threat was contained to ensure the vulnerability does not spread into our systems.
  • Prime has been heavily engaged with our retail pharmacy community to understand their fallback plans and how they’re managing critical member disruption. Initially, we have seen a few different actions begin:
    • Pharmacies with a secondary switch vendor in place have begun to migrate volume to restore adjudication services.
    • Other pharmacies are working on implementing processes to provide short term emergency fill supply to critical patient needs.
    • Prime has instructed impacted pharmacies to direct disrupted members to big chain pharmacies as they currently have the most reliable transactional path.
    • Based on self-reported pharmacy data, Prime has identified approximately 2,500 pharmacies that appear to utilize CHC exclusively.
  • Prime is conducting a data analysis to identify pharmacies that are no longer able to submit claims due to this issue, so we can partner with those pharmacies and our clients on how best to alleviate member disruption.

Q: Is there a confirmed data breach of Prime, client, or member data? 

A: CHC has informed Prime that at this time they are not aware of any of our information being impacted. CHC is conducting a forensic review of their system, as that process evolves, they will notify Prime if any such data is at risk. If Prime is informed of any data breach or privacy issue, our privacy team will promptly follow all applicable privacy protocols.

Q: What security steps has Prime taken to mitigate impact to systems or data?   

A: CHC has disconnected their systems and Prime has blocked connectivity to CHC within our IT network and applications. Prime’s security incident response team is continuing to monitor for updates related to the CHC incident, as well as for any abnormal or suspicious network traffic events. Prime is continuing to monitor application performance and transaction volumes for any abnormalities that could be an indicator of malicious activity. Prime also has engaged with our industry-expert security partner, Mandiant, for additional review of our security measures as an extra precaution.