CVS Drops Major NJ Insurance Carrier: See Who’s Affected

Surging prescription costs mean thousands of New Jersey residents will be seeking new pharmacies to fill their prescriptions, after a pricing dispute led to Horizon NJ Health and CVS Pharmacy parting ways.

CVS Pharmacy will no longer be in-network for Horizon NJ Health members beginning May 1, the insurance company said on its website.

Horizon NJ Health, a subsidiary of Horizon Blue Cross Blue Shield, provides benefits for more than 850,000 NJ residents enrolled in Medicaid or NJ Family Care, serving low-income families, adults with disabilities and children.

Members who use CVS to fill their prescriptions will need to find new pharmacies by April 30, according to Horizon.

The change only affects Horizon's Medicaid and NJ FamilyCare participants. It does not affect Horizon NJ TotalCare (HMO D-SNP) members or Horizon Blue Cross Blue Shield members, Horizon said.

Horizon NJ Health did not provide an estimate of how many of its members use CVS Pharmacy.

"CVS Pharmacy submitted a proposal that was equitable and competitive with other New Jersey Medicaid plans, but Horizon rejected it and demanded rates that are unsustainable for our pharmacy business," CVS said in a statement about the split.

"As a result, CVS Pharmacy will no longer be in Horizon’s Medicaid pharmacy network and nearly a million Medicaid members in New Jersey will lose in-network access to more than 340 convenient locations across the state, including 25 24-hour pharmacies, 200+ drive-thru pharmacies and 50+ pharmacies inside Target stores," the statement said.

"CVS Pharmacy remains in network with the other managed Medicaid plans offered in New Jersey," CVS said.

A Horizon NJ Health spokesman said the company was notified last fall by CVS "that it would leave our Medicaid network unless we agreed to a substantial increase in the cost of prescriptions for our members."

"At a time when too many are already struggling with skyrocketing health care costs and the state’s Medicaid program is being financially strained, CVS’ demands would significantly raise the cost of prescription drugs for Horizon members and the taxpayers who fund Medicaid without delivering any additional benefits," the spokesman said. "Unfortunately, CVS refused to negotiate a fair price and chose instead to leave our Medicaid pharmacy network. We are disappointed by CVS's decision and are working with our impacted HNJH members to ensure they have uninterrupted access to their prescriptions from an in-network pharmacy after the May 1, 2026 effective termination date."

The spokesman said not all Horizon NJ Health members use CVS to fill prescriptions, and said there will be more than 1,500 pharmacies in New Jersey available to those members when CVS ceases to be in network.

Prescription medication costs have risen dramatically in the last five years. A study by the New Jersey Department of Health released in late January showed prescription medication spending per person in New Jersey rose by 50 percent from 2017 to 2022, from $344 in 2017 to $515 in 2022 — and consumers have seen significant increases in 2026 amid a sharp rise in the overall cost of health insurance.

The state has made efforts to curb rising prescription costs. In 2023 then-Gov. Phil Murphy signed bills that capped increases on costs for several common and critically necessary medications, including insulin and EpiPens.

Those laws also led to the creation of the state's Prescription Drug Affordability Council, which is tasked with finding ways to address the high costs of prescription medications.

For now, Horizon NJ Health says members who have been using CVS Pharmacy to fill prescriptions can continue to use them until April 30, but they will need to find a new in-network pharmacy after that date.

"Your new pharmacy will have to contact CVS Pharmacy to transfer your refills or your prescribing provider for new prescriptions," Horizon NJ Health said on its website.

Those affected can call Horizon NJ Health member services at 1-800-682-9090 (TTY 711). They also can search the prescription provider directory.

Members who have more questions about the change and their pharmacy benefits can call Horizon NJ Health's Pharmacy Department at 1-800-682-9094 x81016 (TTY 711), weekdays, 8 a.m. to 5 p.m., and Saturday, 8 a.m. to 4:30 p.m.