Health Plan fix on hold

Submitted by bkrueger on March 17, 2009 - 2:06pm.
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Legislation to shore up the State Health Plan is bogging down under concerns that it could hurt independent pharmacists.

The bill was pulled from the Senate floor for the second straight day and is now scheduled for a vote Thursday, reports Dan Kane. Then it would move to the House.

But House Majority Leader Hugh Holliman said there may not be enough votes to pass the bill in either chamber.

Holliman, a Lexington Democrat, said a lot of lawmakers are concerned about a provision to create a new provider network for so-called “maintenance” drugs that tackle long-term health issues such as high blood pressure or high cholesterol.

Plan officials say the provision would save roughly $90 million over the next two years by reducing the reimbursement rate to pharmacies. The current rate is set by calculating the average wholesale price minus 10 percent. It’s unclear what the new rate would be, but a similar plan in Illinois is average wholesale price minus 25 percent.

Independent pharmacists say they can’t survive that kind of discount. State employees, teachers and retirees are a big part of their customer base, and maintenance drugs are a big part of their business.

Read more after the jump.

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Meanwhile, the company that has the state contract to manage pharmacy benefits, Medco, has a mail-order pharmacy that plan officials say can provide the drugs at a further reduced cost.

The legislation would require $609 million from the state’s general fund to shore up the health plan through June 30, 2011. Premiums, which for all but dependents are paid for by the state, would go up 7.8 percent for each of the next two years.

State employees and teachers have not been receptive to provisions to increase co-payments and deductibles.

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Re: Health Plan fix on hold

Submitted by chance1627 on March 17, 2009 - 6:12pm.

And you'd rather the state administer the plan? Then you'd have T19 type restrictions, HMO's, etc. Ungrateful feeder at the public trough.

Go get a real job and quit whining.

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Re: Health Plan fix on hold

Submitted by alaskan1 on March 17, 2009 - 6:06pm.

If yoyu can find another job in the private sector -- go for it.

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Re: Health Plan fix on hold

Submitted by RJMFJM on March 17, 2009 - 2:46pm.

As a State employee who works for less than I would earn in the private sector, I am very concerned to have my earnings eroded further by having to pay increased deductibles and co-payments. It is clear to me that we won't be getting a raise this year due to economic conditions, even though costs for most necessities has risen. Like everyone else, I struggle to pay my bills now. I have two medications I take regularly, and one is not available as a generic so my cost will increase. In addition, my chiropractor is one of the health professionals I see, and the co-pay to see him will also increase because he is deemed to be a "specialist".

While not a personal issue for me, the fact that it is proposed that step-children cannot be covered unless living full-time with the insured member, is going to create a terrible situation for many people. If a father is required by court order to cover his children who are with him part time, what does he do? Not much forethought went into this one.

My hope is that the Legislature will re-think the proposed changes, and not ask State employees and retirees to bear the consequences of underestimates of the cost of the PPO program, and the large payments made to Blue Cross/Blue Shield for processing of claims.

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