CHARLESTON, W.Va. -- House Speaker Rick Thompson, D-Wayne, raised concerns Wednesday that a Public Employees Insurance Agency drug formulary that goes into effect Sunday could force insurees to do without life-saving medications.
Beginning Sunday, a number of brand-name prescription drugs not on PEIA's preferred drug list will become Tier III drugs. PEIA insurees who remain on those prescriptions will have to pay 75 percent of the cost out of pocket.
"The point is, they're paying three-quarters of the cost of their medication, even though they have insurance," said Thompson, who said that could leave public employees unable to afford their prescribed medications.
PEIA Executive Director Ted Cheatham said PEIA and its pharmacy benefit manager, Express Scripts, have taken every step possible to notify affected insurees and to encourage them to switch to equivalent generic or preferred-brand drugs.
That included sending notification letters this month to all insurees taking what will become Tier III drugs.
"There are legitimate alternatives, and our goal is to notify people on a long-term maintenance drug that there is an equivalent generic or preferred brand," Cheatham said.
Also, he said that following public hearings last fall, PEIA decided to grandfather in several classifications of brand-name drugs that would have been moved to Tier III. Those prescriptions will be available with an $85 co-pay rather than the 75 percent co-insurance cost.
Cheatham said the changes would reduce PEIA's prescription drug costs by about $18 million a year.
Thompson, however, questioned whether PEIA was allowing Express Scripts to dictate medical care standards for public employees.
"I'm having trouble with that concept," he said.