SAN ANTONIO, Texas, – Pharmacies across Defense Health Network Central have been working around the clock to fill prescriptions and care for patients after a Feb. 21 cyberattack on Change Healthcare spurred an enterprise-wide, claims-processing outage.

With the issue still ongoing, Air Force Maj. Gen. Thomas Harrell, DHN Central director and 59th Medical Wing commander, praised the ongoing, extensive efforts of pharmacy teams across his network of 39 military hospitals and clinics.
“Our teams’ efforts to ensure prescription needs are met in a safe, timely manner have been nothing less than extraordinary,” he said. “Our medical leaders and pharmacy professionals have been working diligently and implementing solutions behind the scenes to keep the challenges as transparent as possible for our beneficiaries.”

Shortly after the cyberattack, Change Healthcare disconnected its systems to protect patient information, leaving military pharmacies worldwide and some retail pharmacies stateside unable to process claims for reimbursement. To avoid a complete outage of services, military pharmacies implemented a manual claims process and prioritized acute medication fills, while working long hours to reduce delays for patients with routine, non-urgent prescriptions.

‘Conquering the worldwide outage’
At Maxwell Air Force Base, Ala., the 42nd Medical Group swiftly shifted operations to ensure uninterrupted services to their 42,000 beneficiaries.

According to the group’s leadership, the clinic mitigated the 300% increase in manual workload by focusing on acute prescription processing for the first few days of the outage. As the outage continued, the team avoided delays by repositioning personnel to process acute prescriptions, while simultaneously manually processing over 1,800 refill prescriptions.

“The pharmacy team at Maxwell stepped up to the challenge, putting patients first and surging capabilities in the face of such a significant systems outage,” said Air Force Lt. Col. DeAndra Price-Newby, 42nd Healthcare Operations Squadron commander. “We were able to leverage our relationships with installation mission partners to quickly share information. We are so proud of our team’s hard work!”
In short, with hard work and compassionate care, the Maxwell team “conquered the worldwide claims processing outage,” she said.

As with Maxwell, the 436th Medical Group pharmacy team at Dover Air Force Base, Del., also rapidly responded. Upon notification of the outage, they instituted their heavily trained continuity of operations plan, which entailed shifting to paper forms and workflows to fill acute prescriptions, explained Air Force Lt. Col. Justin Eder, 436th Healthcare Operations Squadron commander.

In the following days, the clinic implemented Defense Health Agency’s downtime operations plan to successfully prioritize acute, routine, and refill prescriptions accordingly, and returned to 95% operational capability within three days. The team continues to address patient concerns related to prior authorizations and other electronic checks, which are now being completed via manual processes.

“Our aim is to avoid unnecessary gaps in care and provide exceptional care, anytime, anywhere -always,” Eder said.
At Kirtland Air Force Base, N.M., the pharmacy focused on fills and processed nearly 3,000 prescriptions in a recent 10-day period. As the 377th Medical Group noted on social media, the pharmacy team is “working tirelessly to ensure our community receives the medications they need.”

As they worked behind the scenes to sustain operations, the 5th Medical Group at Minot Air Force Base, N.D., also engaged with the public to ensure patients were tracking potential delays to both new and refill requests.
“We engaged with leadership across the installation and with beneficiaries to ensure all were aware of the potential for longer wait times due to verification procedures being performed by pharmacy staff to ensure appropriate safety measures,” said Air Force Col. Shaun Westphal, 5th Medical Group commander.
“We were determined to continue supporting the mission of 5th Bomb Wing and 91st Missile Wing while, at the same time, ensuring patient safety,” he said.

Ready and resilient
At Joint Base San Antonio-Lackland, the 59th Medical Wing pharmacy team quickly implemented emergency plans to continue serving patients and sustain medical support to the Air Force Basic Military Training mission. Additionally, they assisted other military pharmacies during the initial stages of the outage in finding solutions.
Ultimately, the wing’s pharmacy never stopped providing medical care, dispensing over 70,000 prescriptions during the downtime, with more being added each day, according to wing leadership.

The team at Vance Air Force Base, Okla., credited their strong policies and readiness posture for their swift return to pharmacy operations.

“What I saw during this challenge was a resilient team able to see the things that mattered and prioritize regaining capabilities for those areas,” said Air Force Maj. Charles Smith, 71st Medical Group’s Diagnostics and Therapeutics Flight commander.

The Vance community appears to agree with Smith’s assessment. Vance’s pharmacy is ranked No. 2 in the “Overall Experience with Pharmacy” category of the Joint Outpatient Evaluations Survey, or JOES. The No. 1 spot currently belongs to the pharmacy on Kadena Air Base in Japan, another DHN Central clinic, for their exceptional efforts.

Meanwhile, overseas…
Along with shifting pharmacy operations, DHN Central’s overseas facilities in Japan, South Korea and Guam had a few additional challenges to overcome, to include information delays due to time-zone differences and a patient population with fewer pharmacy options overseas, resulting in a greater reliance on military care. With these challenges in mind, overseas pharmacies focused on ensuring speedy, but safe, prescription services.

In South Korea, for example, the 8th Medical Group at Kunsan Air Base quickly implemented a workaround to continue dispensing prescriptions to their 2,700 beneficiaries. Using clinical expertise, the team prioritized safety by manually screening for interactions and prior authorization requirements that may have been missed by the system during the outage, leaders said.

“The 8th Medical Group pharmacy is an essential part of medical care provided to DoD members serving overseas at Kunsan Air Base,” said Air Force Capt. Vivian Tran, Pharmacy Flight commander. “We are sensitive to the fact that most beneficiaries stationed here do not have a personal vehicle and rely on us for their care. We will continue to implement workarounds to maintain operations until the impacts of the cyberattack are resolved.”

At Kadena Air Base, Japan, the 18th Medical Group pharmacy team worked diligently to maintain “business as usual” for 99% of their prescriptions, with a minimal increase in wait times, noted Air Force Maj. Julia Comitalo, 18th Medical Group Diagnostics and Therapeutics Flight commander.
“We wanted to ensure as little interruption to our patients as possible since they have far fewer options for overseas pharmacy care,” she explained.

Due to an initial delay in information due to the time difference, the 36th Medical Group pharmacy team at Andersen Air Base, Guam, had to “spring into action,” using local emergency operation capabilities to avoid delays in pharmacy care as they awaited additional guidance, explained Air Force Maj. Timothy Corbin, 36th Medical Group Therapeutics Flight commander.

As an added challenge, the outage occurred during U.S. Pacific Air Force’s largest annual, multilateral exercise, which brought over 2,000 deployers to Guam. The pharmacy team sustained operations by working with the deployed medical teams and local providers, enabling the deployers to carry out their missions and continue to strengthen relationships with global partners, Corbin noted.

“The Andersen pharmacy team has been able to dispense over 3,000 medications during this continued downtime with no shortfalls or outages to their operations,” Corbin said. “We are very proud of our team for being able to maintain operations and provide medication support to deployers.”

Staying in the know
Along with updates, medical facilities across the network also focused on ensuring patients were equipped with helpful information. Many encouraged patients to verify contact information to ensure pharmacy notifications are received and to keep receipts and prescription information on hand in case they need to file a reimbursement claim for out-of-pocket costs. For more information, visit https://www.tricare.mil/pharmacyclaims.

As another option, eligible beneficiaries can use Express Scripts for the convenience of home delivery and the option of a 90-day supply. For more information, visit https://militaryrx.express-scripts.com/home-delivery.
As Change Healthcare works to restore its system, military pharmacies will continue to put patients first, the network director noted.

“As evidenced by the amazing work taking place across the Military Health System, we are committed to delivering Ready, Reliable Care no matter the circumstance,” Harrell said. “We appreciate our patients’ support and understanding as we continue to work to minimize the impacts of this outage while ensuring safe, quality care.”

For updates or more information, visit https://newsroom.tricare.mil/News/TRICARE-News/Article/3684541/change-healthcare-cyberattack-impact-on-mhs-pharmacy-operations.