30,000 state employees, teachers poised to lose name-brand prescription coverage under state plan

Some people covered by the state plan don't believe the substitute medication suggested for them will work and feel that the state is inserting itself between them and their doctor.

More than 30,000 state and public school employees received letters this week informing them their medications will no longer be covered under the state's prescription drug program as of July 1 — the results of an effort by state leaders to save money.

A little-known board comprised of 14 state government leaders voted in August 2021 to make the changes to the prescription plan, according to meeting minutes. A spokesperson for the Mississippi Department of Finance and Administration said the change was made after COVID-19 caused an increase in costs. The change will save the state an estimated $15 to $18 million, according to DFA.

Earlier this year, lawmakers appropriated $60 million in American Rescue Plan Act funding to the plan to offset COVID-related losses.

Almost 197,000 state employees, dependents, spouses and retirees receive state health insurance benefits. The health benefits are administered by Blue Cross & Blue Shield of Mississippi, and CVS Caremark is the pharmacy benefit manager for the prescription drug program.

"This is a way to curb those costs and continue to provide excellent coverage to state employees," DFA spokesperson Marcy Scoggins said in an emailed statement. "An external advisory board of doctors and pharmacists recommends to CVS Caremark what (medication) substitutions are allowed. In the majority of cases, the substitute has the same efficacy at a lower cost."

But some covered by the plan don't believe the substitute medicine CVS Caremark suggested for them will work and feel that the state is inserting itself between them and their doctor.

One school administrator, who did not want her name used because of her employment, received a letter about medication she began taking several months ago for a thyroid condition. Her plan would no longer cover it beginning July 1, the letter from CVS Caremark and DFA stated.

The medicine, Armour Thyroid, costs about $100 a bottle. She was previously paying a $25 copay.

"When they change medicines like that, you have to start the process all over and go through, 'Well this dosage is not enough, this dosage is too much,' and have your levels drawn every so often," she said.

She said she doesn't understand why anyone besides her doctor is dictating what medicine she should take.

"I'm just aggravated. It's like they think they know better than what my doctor knows," she said.

A teacher, who did not want her name used in a story for fear of retribution, first received a notice from CVS Caremark dated May 11 that Ozempic, her medicine for insulin resistance, will no longer be covered. The company wrote that "… starting July 1, 2022, you'll have to change to a preferred medication."

The preferred medicine listed was metformin, but she has already been taking that medication for nearly a decade, she said.

"On metformin alone, we weren't having any success … so (the doctor) said, 'Let's try this,' and it was like magic," she said, referring to the once-weekly injectable Ozempic.

The retail price for the drug is around $1,000. With insurance coverage, the teacher currently pays a $25 copay.

After talking to her doctor about submitting a prior authorization form – which the company could then approve or deny and continue covering the Ozempic – she got another letter the following week.

"Starting July 1, 2022, there will be a limit on the amount of medication that your plan will cover. Once you reach the limit, you will have to pay the entire cost for additional medication which exceeds the limit," the May 17 letter stated.

The limited amount covers what she takes, but she says she's still a bit confused.

"I'm scared that they will jerk the rug out from under me mid-year and send another letter saying my medication won't be covered," she said.

An employee at the University of Mississippi Medical Center, who also did not want her name used because of her job, has been using Synthroid for 10 years since having her thyroid removed. She's tried the generic that CVS Caremark has suggested for her, but it doesn't work.

"We tried all different types of replacement hormones and different doses, and I'm now stable on one, and I don't want to change again," she said. "It just seems flippant to me that they assume everyone can switch from Synthroid to the generic."

She said she plans to try to qualify for a special savings program with the company. If that fails, she plans to talk to a friend whose doctor orders the drug from a Canadian pharmacy at a less expensive price.

The last time similar changes were made to state employees' prescription coverage was in 2019, according to DFA. DFA did not answer follow-up questions from Mississippi Today about how many people were affected and the amount of money saved that year.

The state health insurance plan's reserves have dwindled from $274 million in 2015 to $113 million in 2020, according to a presentation made by Cindy Bradshaw, state insurance administrator, to the Senate Education Committee in September 2021.

Drug claims have increased every year in that same time period except for one, with the most recent increase of 5% occurring in 2020.

-- Article credit to Kate Royals of Mississippi Today