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Published on November 05, 2021

Gundersen Moundview Pharmacy experiencing insurance approval delays

Gundersen Moundview Pharmacy, formerly Phillips Roche-a-Cri Pharmacy, is experiencing delays with the approval of some insurance company contracts.

With the recent change in ownership, the pharmacy was required to submit new contracts to insurance companies. Gundersen submitted these contracts six months before the ownership changed in the hopes that all insurance plans would be eligible on the new pharmacy’s opening day. While many plans were approved, some insurance companies have not completed work on their end which has delayed the approval process.

"We continue to serve all pharmacy customers and still accept Medicare and Medicaid, but we are not considered in-network for some insurance plans at this time," shares Frank Perez-Guerra, administrator at Gundersen Moundview Hospital and Clinics. "This is a temporary situation. Customers impacted by the insurance delays are primarily those with commercial and Medicare Part D plans through CareMark, which is the largest pharmacy insurance company in the U.S. We are working with organizations and individuals outside of Gundersen to help move this process forward. "  

The insurance delays have also impacted the choices customers have when enrolling in Medicare Part D plans. Gundersen Moundview Pharmacy is not currently listed as an option for some plans. 

Pharmacy staff are working very hard to meet the medication needs of customers impacted by the delays. This includes filling prescriptions through other Gundersen Pharmacies, taking cash payments for medications, encouraging the use of insurance mail-order prescriptions and assisting in transferring prescriptions to other pharmacies.

"We realize this is a hardship and inconvenience for our customers," says Perez-Guerra. "We are the only retail pharmacy in Adams County and understand the impact that this is having on the communities we serve. Your patience is appreciated. We do not know how long it will take for the remaining insurance plans to be approved, but we hope it is by the time you read this."

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