‘Medicaid situation with Guam pharmacies being worked on’

The CNMI State Medicaid Agency confirms that Guam pharmacies currently do not accept CNMI Medicaid to cover—fully or partially—medication for most CNMI referral patients seeking treatment in Guam, but this is situation is temporary and a resolution is now being worked on.

According to Vicenta Borja, CNMI State Medicaid Agency acting director, Guam pharmacies are not accepting CNMI Medicaid “at this time, but we are working on it. We are discussing this with Region 9; we are trying to address the issue,” she said.

She explained that this is simply because there is no contract between the CNMI’s State Medicaid agency and Guam pharmacies that reimbursements will be provided.

“In order for the CNMI Medicaid program to pay for services outside of the CNMI, contracts need to be executed. With Guam, it is mandatory. So any patient that will be sent to Guam, a contract must be in place in order for us to reimburse the providers. There is a limited [number] of providers…that are contracted with us. However, we are trying to expand. Right now, we don’t have any contracts with the pharmacies in Guam. However, Medicaid does have a small number of contracts with healthcare providers [in] Guam,” she said.

Meanwhile, Commonwealth Healthcare Corp. CEO Esther Muña reiterated that Medical Referral is not considered an insurance.

“Medical Referral is not a payer; we are not considered an insurance. It is used as a means to coordinate access to [off-island] care in a cost-efficient way,” she said.

However, Muña also shared that the program does make exceptions on a case-by-case basis. This essentially means if it is a life-or-death situation and there really is no other resource to exhaust for a Medical Referral patient, then Medicaid may cover a portion of the needed medication.

“We have a CNMI Medicaid office [in] Guam. Our Medical Referral patients are always welcome to visit the office and inform them of their situation,” she said.

Sen. Paul Manglona (Ind-Rota) earlier wrote Muña and Borja, asking them to address the issue of Guam pharmacies no longer accepting CNMI Medicaid to cover prescriptions for CNMI medical referral patients who are seeking treatment in Guam.

In his letter, Manglona said it was recently brought to his attention that pharmacies in Guam are no longer accepting CNMI Medicaid to cover prescriptions issued by Guam-based physicians to CNMI medical referral patients.