Employee Health Insurance - Plan Modifications (language only)

Item 86 #1h

Language
Page 82, after line 46, insert:
"E.1. The Department of Human Resources Management is hereby authorized to enhance savings and efficiencies within the State Employee Health Insurance plan through the increased use of pharmacy management best practices.  These best practices shall include the expansion of the preferred drug step therapy program to include additional therapeutic classes.   Anti-depressant and Anti-psychotic drug classes are specifically prohibited from inclusion in the preferred drug step therapy program.  Furthermore, the Department is prohibited from modifying current policies related to the purchase of pharmacy products from retail pharmacies or mail order.
2.  The Department is authorized, effective July 1, 2009, to modify the cost sharing requirements for employees and early retirees covered under the COVA care plan as follows: a) increase the copayment for tier 2 drugs from $20 to $25, b) increase the copayment for tier 3 drugs from $35 to $40, c) create a tier 4 drug class with a copayment of $50 per script, d) increase the copayment for office visits to specialist, excluding physical and speech therapy, from $35 to $40, and e.) decrease the copayment for behavioral health office visits from $35 to $25.  Furthermore, to the extent possible, the Department is authorized to increase the copayment for nonsedating antihistamines within the current copayment structure.
3.  Effective July 1, 2009, the Department shall eliminate coverage of surgery procedures to treat morbid obesity under the State Employee Health insurance plan."

Explanation
(This amendment specifies the plan changes authorized for the State Employee Health Insurance plan. The introduced budget provided no additional funding for state employee health insurance premiums based partly on program changes assumed but not specified in the budget. The cost sharing increases assumed in the introduced budget included i.) a $10 increase in the copayment for tier 2 and 3 drugs, ii.) the establishment of a tier 4 for high cost drugs with a $60 copayment, iii.) a $10 increase in the copayment for specialist visits and iv.) increases in the co-insurance for lab & x-ray services, v.) increases in the annual deductible and vi.) increase in the annual out of pocket maximums.)