Commonwealth Choice Members Opting For No Drug Coverage Plans

July 13, 2007

One third of the 15,000 individuals who have signed up for the state's non-subsidized health insurance products have opted for a plan that does not include drug coverage. This market reality is at odds with the state Connector Authority board that has already approved regulations dictating minimum coverage that nearly all individuals will need to purchase by Jan. 1, 2009 or face financial penalties.

The Connector board and staff members yesterday discussed ways to make the soon-to-be-mandated benefit more affordable. The minimum standards mandate drug coverage and permit a maximum upfront deductible of $250 for individuals and $500 for families.

The Connector staff believes it is possible to provide enrollees in Commonwealth Choice plans with some prescription drug coverage for an increase in premiums of less than 10 percent. This increase assumes more out of pocket costs for co-pays for generic drugs without an upfront deductible and co-pays for brand name drugs varying between $30 to $50 after individuals meet up to $1,000 in deductibles.

Many business groups are claiming that individuals should be able to choose whether they want drug coverage and advocacy organizations are calling the benefit essential for adequate insurance and medical care. The Connector Authority reported that a typical prescription drug benefit in the state represents about 15 to 20 percent of the total plan premium.

Also, the Connector recently reported that 27,000 individuals signed up for insurance, with 12,000 individuals enrolled in Commonwealth Care products.

Finally, the State Division of Health Care Finance and Policy (DHCFP) also proposed rules for the Health Safety Net Trust Fund, which was created by last year´s health reform law as the successor to the state's Uncompensated Care Pool. We will be reporting more on this as we analyze the proposed regulations.

Please feel free to e-mail any questions, comments or concerns. We will continue to update you as more information becomes available.

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