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Committee delays prescription copay changes pending utilization data
Summary
The subcommittee discussed raising brand-name retail copays to encourage generics but decided not to change the prescription structure without data on how many employees would be affected. Dr. Clauson requested prescription counts by tier for future consideration.
Nancy Bellosa of EBC outlined a prescription-copay redesign that would keep generics at $30 but raise brand-name retail copays from $40 and $55 to $75 and $150, respectively, and apply a 2x mail-order differential. The consultant estimated that change could generate about 2.11% in premium savings, but committee members questioned whether that savings justified the disruption to individuals relying on brand medications.
The committee "concurred with the administrative recommendation that the District hold on any changes to the prescription drug copay structure" and asked staff to provide counts of prescriptions in each cost tier so the committee can better estimate how many people would be affected before deciding on any benefit change.
