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PEHP begins new core system; pharmacists warn PBM contracting and low dispensing fees threaten local pharmacies
Summary
The Public Employees Health Program (PEHP) told the committee it has started a phased rollout of a new core claims system and new member cards; independent pharmacy representatives testified that pharmacy benefit manager (PBM) contracting and low dispensing-fee reimbursement squeeze community pharmacies and reduce access.
PEHP representatives told the Retirement and Independent Entities Committee that the health-plan administrator has begun transitioning members to a new core claims system and distributing new member cards that carry a July effective member number, while independent pharmacists and the Utah Pharmacy Association pressed lawmakers about pharmacy reimbursement and pharmacy-benefit-manager (PBM) contracting practices.
Chet Loftus, speaking for PEHP, described a multi-year effort to replace an aging internal IT platform with a configurable vendor-backed system intended to increase automation and reduce manual claims adjudication. PEHP has run pilot cohorts (including a January 2023 group) and completed phased work needed to issue new member cards. Loftus asked members and providers to use the existing PEHP card through June 30 and to present the new card (the number begins with an "M" and the card is marked "JUL") to providers on July 1 to ensure claims route to the correct system. "The old system is…
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