By Sarah Plummer
While the Public Employees Insurance Agency (PEIA) is not suggesting increases in premiums for the fiscal year 2014, educators expressed concerns during a public hearing Monday over low-wage, teachers being saddled with increased co-pays and higher prescription costs.
“In the past, public and education employees viewed PEIA as part of a benefit package that enhanced their compensation package and compensated for low pay,” said Wayne Spangler, Monroe County teacher and vice-president of the West Virginia Education Association. “If public employees fail to see richer benefits than their counterparts in the private sector while they are continually denied pay raises, the state must expect the depletion of workers to private industry and the loss of many to other states.”
As was adopted by the PEIA Finance Board last year, Plan A, B and D will have family out-of-pocket maximums that are twice the single rate.
This year they are 1.5 times the single rate.
PEIA Director Ted Cheatham explained that in 2014, Plan B, C and D will have a lower premium and plan A will be about 1 percent higher.
For many, however, the biggest proposed changed has to do with co-pay increases for specialty drugs, from $50 to $85 per 30-day supply of generic specialty and preferred brand name medications.
Insurance holders are responsible for a $100 co-pay on supplies of non-preferred brand specialty medications.
Cheatham did say that there is a possibility the company might create a new specialty benefit, but the specifics were not delineated.
Cheatham also told the 50 individuals in attendance that PEIA is going to loose $35 million during 2014 by spending down their reserve to a statutory 15 percent minimum.
Christine Campbell, president of American Federation of Teachers, West Virginia, commented, “We have seen no pay increase for four of the last give years. We cannot afford more benefit cuts like specialty drugs. The elimination of retirement subsidy makes it harder for us to attract qualified teachers to West Virginia.”
Spangler noted that while premiums would not be increasing during 2014, fiscal year 2015 shows a 9 percent premium increase.
He urged PEIA to find a way to reduce or offset that impending blow.
He also asked that PEIA notify all members who are currently taking specialty medications that their cost will be increase. In addition, he asked that PEIA develop an internal review procedure.
“When generic or non-preferred drugs do not work for an individual or are considered to be unsafe, the member should be given an option for lower payments the brand name or non-preferred is required by their doctor,” he said.
Cheatham next noted that PEIA will accept a wider range of wellness programs that count toward a $10 a month premium discount.
And the Weight Management Program, which had been a once in a lifetime benefit, will now be allowed a second time for those who dropped the program or who were not successful the first time.
Moreover, starting on April 1, everyone will be considered to use tobacco — “a positive enrollment” in the Tobacco Cessation Program. Forms will be mailed to individual enrollees and they must mark that they do not use tobacco and return the form, said the director.
The final change to the Wellness Programs is that those who are enrolled in a Face to Face Diabetes Management Program will no longer have waived copayment for third-tier, non-preferred brand name diabetes medications. Co-pays will still be waived for generics and preferred drugs.
Starting in 2014, Medicare and non-Medicare retirees will have the choice to enroll in a lower premium, second plan.
Plan B for retirees not yet 65 will be about 10 to 15 percent cheaper regarding premiums, said Cheatham.
The medical deductible, medical out-of-pocket maximum, and prescription drug deductible will be double on Plan B.
The preferred brand drug co-pay will go from $15 to $20.
Likewise, while the alternative plan, Silver, for retirees over 65 will have premiums about 30 percent less than the existing Gold plan, there are substantial increases in benefits.
The medical deductible, for instance, increases from $25 to $250 and the inpatient hospital co-pay increased from $100 to $150.
Spangler said the West Virginia Education Association was “leery” of lower premium costs being used to entice retirees on a shrinking budget.
He asked that the details of these programs be offered side-by-side with the existing plans so that each person can make an informed decision.
Also making their voices heard were area physical therapists.
Lori Lovern, who practices in Princeton, explained that combining physical therapy with other outpatient services means her patients are paying a $10 office co-pay in addition to a co-insurance fee for the first 20 visits.
This can add up to more than $100 per week for those who need treatment 2 or 3 times a week.
Mick Bates, of Bodyworks in Beckley, agreed and asked PEIA to look over a medical benefit plan design produced by the American Physical Therapy Association.
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