Pennsylvanians Should Stop, Ask and Confirm: Local Pharmacy May Still Be In-Network for Insurance Coverage | Insurance Department | Commonwealth of Pennsylvania

Harrisburg, PA - The Pennsylvania Insurance Department (PID) urges Pennsylvanians to stop, ask, and confirm if their local pharmacy is still in-network for their insurance. PID received reports that some consumers have received letters stating in error that certain local trusted pharmacies are no longer in-network. PID is actively looking into this issue and working with insurers, partner organizations, and state and federal agencies to determine the impact and ensure Pennsylvanians receive accurate information.

"Local pharmacies are a vital part of our communities and health care system," said Pennsylvania Insurance Commissioner Michael Humphreys. "These trusted partners provide accessible, personalized care, medication counseling, and help managing chronic conditions, especially for seniors and individuals in rural or underserved areas. Ensuring accurate information about pharmacy network status aligns with the Administration's ongoing focus on transparency and accountability and protects access to local health care services. Incorrect information disrupts care, creates unnecessary stress for consumers and can unfairly economically damage providers that were never out of network in the first place."

Pennsylvanians who received a letter stating that their local pharmacy is no longer in their insurance network should not assume the letter is correct. Instead, they should call their insurance company or pharmacy benefits manager (PBM) directly and ask if the pharmacy is still in-network for their insurance plan. In examples shared with PID, the PBM later sent a letter to correct the inaccurate first letter to confirm that the consumer's preferred pharmacy, in fact, remained in-network.

The Shapiro Administration has consistently emphasized that community and independent pharmacies are essential to health care access in Pennsylvania, particularly because they provide personalized prescription services close to home that large chain or mail-order options often do not. Governor Josh Shapiro has highlighted that local pharmacies play a critical role in helping Pennsylvanians manage chronic conditions, understand their medications, and receive timely care in their own communities.

Pennsylvanians with questions or complaints about their health insurance can visit pa.gov/consumer or call 1-866-PA-COMPLAINT (1-866-722-6675).

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