CAMBRIA COUNTY, Pa (WJAC) — The Pennsylvania Department of Human Services (DHS) has clarified its role in the ongoing legal battle involving Martella’s Pharmacy and Express Scripts.
The dispute began when Express Scripts terminated its contract with Martella’s, leading to a class-action lawsuit involving patients from Martella’s, against Express Scripts, Highmark, and UPMC, in federal court.
A DHS spokesperson stated that the agency’s primary responsibility is monitoring contracts as they affect Medicaid recipients.
The DHS says they regularly collaborate with independent pharmacies, and have intervened when health plans fail to meet specific requirements.
However, contracts within the state’s Medicaid program are negotiated between Managed Care Organizations and their pharmacy benefit managers, not DHS.
DHS revealed that it was not initially informed of the contract termination and learned about the situation through the Governor’s office and media reports.
Express Scripts had notified UPMC for You customers, via a member notification in July, but did not alert DHS.
DHS confirmed that Martella’s Pharmacies remain in good standing with the state Board of Pharmacy and the DEA.
Express Scripts claims Martella’s violated their contract by failing to disclose disciplinary histories of affiliated pharmacists.
DHS found UPMC for You in violation of two codes for not informing DHS 90 days prior to potential pharmacy terminations.
DHS has since provided training to UPMC pharmacy and PBM staff and conducted an audit review to check for other terminations.
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UPMC has stated it will not issue further notices regarding Martella’s network status until the court rules on the case.