PEIA board approves more than $50M in cuts


Charleston Gazette-Mail

CHARLESTON, W.Va. — Public Employees Insurance Agency Finance Board members approved more than $50 million in 2017-18 plan benefits cuts for state and public school employees, many non-state public employees, and retirees on Thursday.

That includes about $28 million in benefit cuts for state and public school employees, primarily through higher deductibles and out-of-pocket maximums, totaling about $19.4 million, and mandatory 90-day fills for prescriptions for maintenance drugs for chronic conditions.

Board members representing public employees were critical of the cuts, coming less than six months after the Legislature approved a $43.5 million increase in employers’ PEIA premiums, resulting in a $14 million increase in employee premiums.

“We’re talking about real changes to this plan, and it pains me,” said Josh Sword. “It’s sad we’re in this predicament.”

He added, “Here we are, less than a year after the legislative leadership said they fixed PEIA, and we’re taking $50 million away from participants. It’s disgusting.”

Elaine Harris added, “The election’s over. Those who said, ‘I’ve signed off not to do any tax increases,’ this is people’s survival here.”

A key change from the plan proposed in October, based on comments at public hearings around the state, was to enact the 90-day mandatory fills of maintenance drugs, in lieu of higher co-pays for specialty drugs and non-preferred list drugs, and raising prescription drug out-of-pocket maximums.

The 90-day mandatory fill will save about $11 million a year, PEIA executive director Ted Cheatham said, since PEIA will reimburse those prescriptions at mail-order rates.

About 220 of the roughly 550 pharmacies in the state have agreed to fill the 90-day prescriptions, he said.

Richard Stevens, executive director of the West Virginia Pharmacists Association, said small, locally owned pharmacies are not participating because they would lose money filling non-generic 90-day prescriptions for chronic medical conditions.

“Your policy-holders are not going to have access to care,” he told the board. “They’re going to have to drive 30 to 40 miles to get their prescriptions filled, passing pharmacies along the way.”

Cheatham said PEIA opted not to require mail order to fill the 90-day prescriptions in order to keep the business in state.

“What we’re saying is, let’s keep this in West Virginia,” he said.

Stevens called on the Finance Board to investigate Pharmacy Benefits Managers (PBMs), which he said are making massive profits at the expense of consumers and small pharmacies.

At board member Mike Smith’s request, the Finance Board agreed to have a board retreat this winter to study PBM issues.

Meanwhile, non-state employees will see 6-percent premium increases, and retirees will have 4-percent premium increases. Those PEIA insurees are not subject to the 80/20 employer-employee premium match required by law for state and public school employees.

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