Under the new GIC plan, retirees, who are prescribed non-preferred brand name drugs, will be forced to pay a copayment of $25 (retail) to $40 (mail). The GIC has established a listing of drugs, known as a formulary, through its new pharmacy benefits manager (PBM) Express Scripts. Under this system, three separate copayment levels have been put in place; generic, preferred name brand, and non-preferred name brand.

The GIC’s rationale is that retirees and employees should prescribe to the preferred brands whenever necessary. Express Scripts argues that most non-preferred drugs have an equivalent preferred drug available to be substituted. They claim that the preferred and non-preferred drugs are identical in all ways, other than price. Therefore, the thought is to encourage the use of generic or preferred drugs whenever possible.

"We immediately took issue with this three-tiered system once it became obvious that some members would be financially penalized for having to take a non-preferred drug. All things being equal, of course it makes sense to take the less expensive drug. Our concern is what happens when everything is not equal," said Association Legislative Liaison Shawn Duhamel. "Members who are forced to take a non-preferred drug, because it is all that will work in their case, should be allowed to pay the lower copayment. All we are asking for is some fairness for our members."

Joyce / Montigny Take Action

In Conference With House

As of press time in mid-June, the House and Senate budget conferees are locked behind closed doors trying to iron out an agreed upon version of the budget. It is expected to be sent to the desk of Governor Cellucci within the coming weeks.

Since the House version of the budget, passed in April, does not contain the GIC appeal amendment, the issue is subject to negotiation between the two branches. Association lobbyists have provided House Ways and Means Chairman Paul Haley (D-Weymouth) with information on the issue.

"The chairman and the House Ways and Means staff know this is an important issue to our members. We have met with them to discuss our position and I’m confident that they will try to be supportive here," says Association President Ralph White. "Any time there is a conference item you never can be certain of the outcome. The House leadership has been very good to retirees over the years, so I will remain optimistic this time around.

"My larger concern is working with Governor Cellucci and the GIC to gain their support for this process. We do not want to face a gubernatorial veto. I really am hopeful that our members can count on the governor’s support this time around."

The Association has also been working closely with Administration and Finance Undersecretary Peter Forman, as the Administration examines the appeal proposal. Forman is Cellucci’s representative on the GIC and has been assigned the task of researchingways to provide pharmaceutical benefits to the elderly and uninsured population across the state.