Healthcare Prescription Copayments Draw Attention Main Menu
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MAY 2001 -
Insurance Committee Fast To Act - It should come as no surprise to members that issues regarding
prescription drugs remain a hot topic on Beacon Hill. In fact, so much
interest has been drawn to the topic that the Joint Committee on
Insurance addressed two of the more pressing bills at the Committee’s
maiden hearing on March 20.Chaired
by Senator Therese Murray (D-Plymouth) and Representative Ronald
Mariano (D-Quincy), the joint committee was quick to act favorably on
H3353 filed by Rep. Robert Koczera (D-New Bedford). The bill requires
the Group Insurance Commission to establish an appeal process to
address complaints regarding the new three-tiered copayment system.
“This issue is critical to many of our members, so we should be grateful to the Committee for taking quick action,” said Association Legislative Liaison Shawn Duhamel. “The Senate leadership is already on record as supporting this proposal. Hopefully the House can be convinced to follow suit this year.” Last July, the GIC implemented the system for the Indemnity Plan, Plus Plan, and the Commonwealth PPO. Instead of two levels of prescription copayments (generic and name brand), these plans now have three. The third tier represents name brand drugs, which are not offered at a discount price through the preferred formulary. What has outraged many members is the fact that the third tier carries a retail copayment of $25 (30 day supply) and a mail order copayment of $40 (90 day supply). These prices apply regardless of the medical necessity of taking the particular drug. Similar to a measure, sponsored by our Association, that was passed by the Senate last year, H3353 allows retirees and employees, who are insured through the GIC, to obtain non-preferred name brand drugs with preferred copayment. However, in order to obtain the lower rate the member would first have to demonstrate that the particular drug is medically necessary. “Our goal here is to ensure that our members have access to the drugs they need, without being financially penalized. If the doctor can certify that the drug is medically necessary and there is nothing else available, then the lower copayment should apply,” explains Association Insurance Coordinator Cheryl Stillman. Mail Order Targeted A separate bill, also heard by the Insurance Committee on March 20, would have eliminated the discount retirees receive through the mail order program. A group of retail pharmacists, who claim to have lost business due to mail order programs, have filed a bill (H3942) that would require the same copayments apply to mail order and retail alike. The Association joined together with several insurance providers to oppose H3942 and offered testimony before the committee as to the negative impact the bill would have on retirees. If passed, the bill would prohibit the discounted prices achieved through the mail order program. This would result in higher premiums and copayments paid by retirees. “This is a bad bill that is designed simply to protect a certain industry, but at the expense of consumers. Our members greatly utilize the mail order programs offered by the GIC and the municipalities, why should they be forced to spend more money,” commented Duhamel, who presented the Association’s arguments to the committee. “Thankfully, the chairmen recognized the bill was bad for retirees and have stopped the proposal in its tracks.” |
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