CHARLESTON, W.Va. -- Ted Cheatham, executive director of the state Public Employees Insurance Agency, had stayed out of the headlines of late. That's what happens when you manage a health insurance plan that's going into it's third straight year without a premium increase.
However, that changed last week when Cheatham was asked at a legislative interim committee meeting to discuss what impact proposed legislation to make antihistamines containing pseudoephedrine available by prescription only would have on PEIA's expenses.
Cheatham raised eyebrows when he told legislators PEIA actuaries advised the cost could run about $4.3 million a year -- $500,000 for costs of the prescriptions, and $3.8 million for the increase in visits to doctor's offices.
Those of us who look at lots of fiscal notes know that, historically, the default mode for many agency heads is worst-case scenario. (Most famous was the $1.5 billion Department of Education fiscal note for a bill to require daily physical education classes for all students, which assumed the need to build new gyms and athletic fields at all schools.)
In fact, Cheatham subsequently said the cost estimate assumes the Legislature not only made Sudafed prescription-only, but also made it a Class II controlled drug, with 30-day, unrefillable prescriptions, requiring separate doctor's visits for each 30-day supply.
However, as House Health and Human Resources Chairman Don Perdue, D-Wayne, points out, none of the variations of bills to make pseudoephedrine prescription-only would make it a Schedule II controlled substance.
The version that's gotten the farthest (HB2946), which passed the House in the 2011 regular session, and died on a dramatic 16-16 tie in the Senate, would have made it a Class III drug. (Then-Senate President Earl Ray Tomblin was acting as governor at the time, and did not vote, and then-Sen. Walt Helmick took a pass to attend a grandson's birthday lunch.)
That classification, Perdue notes, would have permitted a 30-day prescription with up to five refills, meaning a maximum of two doctor's office visits a year, not 12.
(PEIA's fiscal note on the 2011 bill estimated costs as high as $800,000, but probably closer to $400,000, presuming that many cold and allergy suffers would opt for an over-the-counter alternative rather than going to the doc for a Sudafed script.)
I was privy to some email exchanges between Perdue and Cheatham on the issue, including this one from Cheatham:
"Again, I must reiterate as I did in the committee meeting, this was the first response from the actuary. It is indeed a worse case, conservative scenario. We have not looked at a bill or the refill issue. I just explained the assumptions the actuary used to create these numbers. I would be happy to have the actuary model the scenarios you foresee. Please share your thoughts on needed physician visits and refill guidelines and we will run the scenarios."