–by John Bowman, Greenwich
There has been sparse reporting on the Governor’s cutting the ConnPACE prescription drug program for low-income seniors and disabled; the insidious bait & switch pulled on ConnPACE members has gone unnoticed by the press, possibly because you need to connect a lot of dots to understand it. Here goes.
ConnPACE provides (used to provide) wraparound coverage for low-income seniors’ prescription drugs; Medicare Part D is now the primary insurer, with ConnPACE paying for drugs not in their members’ plan’s formulary (list of drugs they cover) and paying co-pays down to $16.25/prescription (the co-pay that ConnPACE members pay at the checkout counter). ConnPACE also paid when members moved into their plan’s “donut hole.” Now, for any NEW drugs a member needs that are NOT in their Medicare Part D plan’s formulary, ConnPACE will not cover it either.
Medicare Part D plans all have different formularies and costs range from $15/month to $99/month with the more expensive plans covering more different drugs. Members can choose any plan they want, and ConnPACE pays the monthly premium (a federal requirement for state plans like ConnPACE).
Back in November, ConnPACE’s advisory letter to clients urged them to choose cheaper plans, saying in their letter, “As a guide to a cost-effective monthly premium, the Medicare Part D Connecticut regional benchmark premium for 2009 is $31.74. While ConnPACE will pay your Medicare Part D premium even if it exceeds the regional benchmark, you should always be aware of the cost to the state for that premium. If your current Medicare Part D premium is above $31.74, ConnPACE strongly encourages you to consider enrolling in a benchmark plan for 2009, as the benefits provided by all plans are comparable.”
ConnPACE in fact got the average plan cost down to about $20/month. They could ask and expect clients to choose the cheaper plans because, as they advised in the same letter, ConnPACE would cover non-formulary drugs.
But then, in mid-year, the switch. Had members known that ConnPACE would be or might be dropping new non-formulary drug coverage they, logically, would have chosen the best plan with the most drugs in its formulary. When asked about this, David Dearborn, CT DSS Communications Director simply said “In terms of the open enrollment timeframe of last November, the budget situation we now find ourselves in was not known at that point — in terms of lack of budget resolution as the deficits intensified.” Maybe true, although dropping coverage of non-formulary drugs has been in the Governor’s budget proposals for some time now. They certainly did know in May, however, that back in November they wrongly (as it turns out) encouraged ConnPACE members to choose cheaper plans. Based on that alone DSS should not have made this change.
There are fairer alternatives to deal with the budget difficulties. Using figures from the ConnPACE financials, found on their website, it looks like they could cover the cost of new, non-formulary prescriptions by raising the $16.25 co-pay by $2.60. This would spread the cost to all ConnPACE members, rather than making them all play Russian roulette and hoping they aren’t the ones who will need a new non-formulary drug and have to bear all the burden of this cost cut.
If a private insurer were doing this to its clients in Connecticut we would see AG Blumenthal on every TV station announcing his investigations and fines. Since it’s our own state, doing this to its most vulnerable citizens, we should all be screaming.
Note to municipalities and small businesses who might be joining up with Connecticut for health insurance: if they’d do this to low-income seniors and disabled, they would cut you’re plan’s coverage in a heartbeat. The State does not keep its promises.