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PEIA determines ‘maintenance medications’

By DANYEL VanREENEN

The Journal

MARTINSBURG, W.Va.  — As of July 1, West Virginia’s Public Employee Insurance Agency enacted a policy change requiring “maintenance medications” to be filled in 90-day supply, and Reed’s Pharmacy owner and Morgan County Commissioner Ken Reed said the changes are causing emergency room prescriptions to be denied and customers who can’t afford a three-months supply to leave the pharmacy without their medications.

The PEIA is West Virginia’s state and county employee insurance plan, and HealthPlan.org says the agency has over 14,000 members. The agency’s website said it enacted a policy change on July 1 that requires all “maintenance medications” to be filled in a 90-day supply. Defined as “prescription commonly used to treat conditions that are considered chronic or long-term,” the list of medications now requiring a 90-day prescription include medication used to treat ADHD, alzheimer’s disease, cancer, depression, diabetes, heart disease and high blood pressure, glaucoma, immune disorders, irritable bowel syndrome, kidney disease, osteoporosis, parkinson’s disease, rheumatoid arthritis, seizure disorders and thyroid disorders as well as antipsychotics, blood modifiers, contraceptives and respiratory agents.

Reed said medications on the list are required to be filled in a 90-day supply no matter what a doctor writes the prescription for, and customers are required to pay the co-pay for the full 90 days. According to Reed, the PEIA changes do not take into account ER prescriptions or changes in dosing.

“Some of these medications can also be used for other things,” Reed said. “(The new policy) doesn’t account for changes in dosing or changes in insulin. The general rule for medicine is to start low and go slow.”

Changes in insulin dosage is variable, and Reed believes diabetic customers could waste thousands of dollars under the new PEIA policy.

“This change has an extreme potential for waste,” Reed said.

Because the PEIA is West Virginia’s state employee insurance program, Reed said the state will be paying for a share of each 90 day medication supply, and customers will be responsible for paying the co-pay for the prescription. Reed said the PEIA change balances costs on the backs of paying customers and pharmacies.

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