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The Saga of Change Failcare

·1613 words·8 mins

When we last left our hero working in the Angry Pharmacy…… #

March 1st, 2024

We are out almost a grand in coupon card reimbursements. Entire states have their Medicaid systems completely offline and have resorted to using a Google Doc to keep track of reimbursements (fucking lol Utah). Doctors aren’t getting paid for claims. Most of the nation cant bill Medicare-B for strips/lancets/nebulizer sol. The money reserves are drying up and nobody is coming to help us. Pharmacies are in chaos as patients who are on 1 metformin 500/day cant get their Libre CGM sensors refilled. People are losing their shit.

You may be wondering how I got myself in this situation…… #

February 21st (I think), 2024 - 9:00 AM

It was a regular shitty opening at the Angry Pharmacy. The crackheads beloved patients were lined up at our front gates waiting to pay respect to the god of Hydrocodone (Norcodemus) at his alter that is my front counter.

As I try to bill their prescriptions to the shitty insurance that will pay us under cost, I notice that the switch is down.

For those not in pharmacy:

The “Switch” is a single point of computer contact that takes our claim, looks at whats inside, and then directs the claim to the proper PBM for adjudication based on the BIN and PCN number. Its like a telephone switchboard to send claims to the right PBM. If you’re still confused and need pictures:

Why do we need a switch? For ease and simplicity vs requiring every pharmacy in the US keep an up to date database of what claims go to which PBM servers. At the pharmacy level we don’t know where the PBM servers are at, or how to contact them. We contact the switch and they do the rest. This sounds pretty awesome right? However you may be thinking “man, this is a huge single point of failure”.

Spoiler alert: You’re fucking right.

“Huh” I said, with a hint of “god dammit the fucking switch is down again” to my voice. Shit like this happens, however this time was different…..

Now sometimes the switch goes down for short periods of time, normally not more than 25 min or so. This time was especially confusing because AT&T decided to screw-the-pooch with a software upgrade and destroy cellular service to the entire nation. So me, being me, thinks that a fiber got cut and I just have to wait it out. Lots of chatter on just confuses the situation into something that looks more widespread than just our switch. Time for another cup of coffee.

We dispense the medication (thinking the switch was going to come back up) and save a tag to bill it later. Like I said before, usually its back up in a handful of mins. Well and hour and its not up. My butthole starts to pucker and think that something might be very wrong.

Introducing the turd in the toilet, our star of the story, Change Healthcare! #

You see, the switch that we use is ran by Change Healthcare. They used to be on their own until Optum bought them then United Heathcare bought them or something. These PBMs are as inbred as your cousin Larry who lives in a double-wide with your other cousin Tammy and their kids Cleetus and Hunter. Cleetus cant see too good cuz his eyes are messed up, and Hunter, well, we’re not sure what happened to him.

All that’s important is that Change Healthcare is owned by UnitedHealth (I can hear the MD’s in the audience hissing, suck it up buttercup we dealt with their bullshit first). Now Change Healthcare is not only a switch, but a ghetto diet PBM that manages shit like coupon card billing and Medicare-B billing for some pharmacies. They actually do a lot more like have pharmacy software and eRx’ing, but that’s sorta not important at the moment.

I become a hero! #

Now I, despite being a bit slow in somemost aspects of life, are good with the interwebs. If we don’t have internet, we can’t bill claims and the store doesn’t make money. If the switch isn’t up we don’t make money. Due to my touch of autism and a ’everything is going to go wrong at once’ mentality that eats a whole in my gastric lining, I have ANOTHER switch configured in our pharmacy software in case this happens. So I change our switch to Relay Health (the OG switch that everyone loves, who may be owned by Change but maybe not?) and claims go through. My techs celebrate my planning ahead with a nacho potluck and we all ride off into the sunset……. okay that’s a lie, there was no riding off and there wasn’t a nacho potluck. Shit went from bad to catastrophic (not with us, just in general).

Change Healthcare got Hacked. #

Now getting hacked now days can mean a bunch of stuff. You could get Distributed Denial of Service’d off the internet (a bunch of computers send a lot of requests to the switch at once, thereby clogging the internet tubes. Similar to a bunch of people heading to the fire exit all at once. Or they could have not been hacked and just some idiot sysadmin program a bad BGP advertisement; meaning you’re telling the internet that your network is connected to a network that doesn’t even exist thereby delete themselves off the internet for a few hours. Its a very vague term, and the media likes to use it because its scary sounding.

What came next was worse than everyone imagined. Far far worse.

Change Healthcare got Ransomwared. #

Someone got into their network, got to their data, encrypted it all, and is holding the decryption keys in exchange for a ransom. Oh, and they also downloaded all the information they encrypted. Later it came out that it was 6 Terabytes of data. If you could comprehend how much text 6 TB is, it would make your head explode.

On a scale of 1 to absolutely fucked, porn stars are fucked less than Change Healthcare. Change pulled their systems off the internet after they found out they were screwed from heaven, to hell, and back. That’s why they were down.

To put in perspective, if the hackers actually compromised the switch database, they have PHI and medication records of more people than you can even comprehend. This is so fucking bad I cant even put it into words. Well, I’m going to try:

  • Medical records of people who would pay good money to not have the following leaked to the press or the public
    • HIV meds
    • Herpes meds
    • Dick Pills
    • Abortion meds
    • Fucking anything sensitive medical-wise. The above is just pharmacy records, who knows what else they got!

From what I can gather, most doctors cannot get paid for claims because they all go through Change Healthcare. Some pharmacies have their pharmacy software tied to Change so they cant even get into their pharmacy systems! I just got a text (as I was writing this) from an ER Pharmacist friend that they can’t send eRx’s to certain stores at all. Talk about fucked.

Why this sucks and why its sorta good #

The not-really silver lining to this whole clusterfuck, is because people cannot get their medication, it shows the public what an absolute stranglehold the PBM’s have on the industry. What we have been screaming about in pharmacy for the last 10+ years is finally having a real-life impact on the public, the politicians (who are bribed to fuck by the PBMs, but now they have to do something), and the MD’s. The PBM’s have way too much power, and too much data is concentrated in too few spots. There’s no checks and balances nor is there any real competition (Fuck you PCMA and your bullshit propaganda). If one outfit can bring down one company and grind Rx transactions to a halt, how resilient is that from attacks from say another nation?

Optum decides to kick us when we’re down #

The latest kick in the nuts to an already fucked situation is Optum (Part of UnitedHealth who owns Change Healthcare, our star of the show) is offering loans. You cant make this shit up.

So they are going to offer a ’loan’ because their sister company couldn’t design their fucking network so a compromised server would be isolated from shit that PHI was stored on. That’s like having VISA offer you a loan because their servers are offline so they cant deposit your funds into your account.

So what now? #

Nobody knows what Change Healthcare is going to do. Are they going to pay the ransom and hope the outfit who stole their data doesn’t turn around and just sell it a year later? Do they have backup servers? The president of UnitedHealth went on record to say that this outage is supposed to last several weeks. Several fucking weeks. So many clinics and pharmacies that rely on Change Healthcare are going to be out of business.

As I type this, most pharmacies have deployed workarounds to use Relay Health to bill claims. Coupon cards that were administered by Change Healthcare (remember they are a diet PBM too) and Medicare-B claims are still offline. Some grocery store chains cannot receive eRx’s from places like hospitals and clinics.

The Angry Pharmacist
The Angry Pharmacist
Started this site in 2005 out of frustration that pharmacy school does not prepare you for dealing with the ungrateful unwashed public. Was hugely popular until life called and I had to take a break. Now I try to provide low brow potty humor that applies to the pharmacy population at large. Except you clinical fucks, go play doctor with your white coats and snobby attitude.