Connector Board Weighs Drug Benefit Options for 2009

October 12, 2007

At Thursday´s Connector Board meeting discussion centered around proposals for mandated prescription drug coverage. Drug coverage must be included in health plans as part of "minimum creditable coverage" requirement by January 2009.

As of March, an estimated 160,000 Bay State residents who purchased health insurance or got it through an employer did not have prescription drug coverage, according to the Commonwealth Health Insurance Connector Authority. That number is execting to skyrocket as individuals purchase low cost - low coverage plans. It was also noted that 30 percent of the 8,300 residents enrolling in private sector Commonwealth Choice plans are opting out of plans offering prescription drug coverage.

Concerns were raised about proposals for premiums and deductibles that put deductibles into three tiers, including generic drugs, preferred brand-name drugs and non-preferred brand-name drugs. The tiers are meant to allow for cost-sharing for primarily generic medications and brand-name drugs. Co-pays for 20-year olds ranged between $15 and $20. For 60-year olds, co-pays ranged from $30 to $40.

According to the State House News service board members reacted to a plan with a $1,000 deductible with brand-name drugs:

• Rick Lord, president of the Associated Industries of Massachusetts said "I don't think we've exhausted all the possibilities," he said. "I think this is a conversation we need to continue to have."
• Board member Nancy Turnbull, a Harvard lecturer and former Blue Cross Blue Shield Foundation president, noted that some individuals have conditions where brand-name drugs are needed, with no generic alternatives. "That's a big change in minimum creditable coverage," she said. "I worry about the people who have high drug costs and don't have any choices."
• That could be a problem for the elderly or women who use the "morning after pill," also known as Plan B, according to Dolores Mitchell, the head of the state Group Insurance Commission who sits on the board. Mitchell said they could also go the opposite route: cover brand-name drugs and not the generics. She also urged the authority to go back to the health plans, which pushed back on covering certain brand drugs without an upfront deductible, including anti-asthmatic inhalers and immunosuppressants. "I think we ought to push them a little harder, myself," she said.
• Board member, economist John Gruber, argued that for brand-name drugs, the price could be upped while taking the price for generics down. "The vast majority of people can benefit from generics," he said. "People can buy up."

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