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County commissioners opt for prescription co-pay plan

Nov 14, 2012 - By Christina George, Staff Writer

The vote was 4-1 to approve the plan change, with Commissioner Pat Hickerson casting the lone nay vote.

Beginning Jan. 1, employees who use the Fremont County health plan will use a co-payment process when purchasing prescription medications.

Employees currently follow an indemnity-style model, which combines medical services and prescriptions under a single deductible and coinsurance requirement. Under this plan, employees must pay the medication's cost up front and then be reimbursed later.

Co-pay plans allow the individual to obtain needed medications at a lower cost share per prescription and not pay the full cost.

Fremont County commissioners voted 4-1 to approve the plan change, with vice chairman Pat Hickerson casting the lone nay vote.

The recommendation to amend the health plan came from the county executive health committee and a Colorado-based company, Cobecon, which conducted a prescription benefit analysis.

The decision followed a presentation by Cobecon vice president of sales Rob Henderson.

Henderson said medical services and prescription costs are currently applied to an employee's annual deductible, which provides them the opportunity to reach the deductible sooner.

A downside is that because employees have to pay the full amount for a prescription drug up front and then wait for a reimbursement, some may not be inclined to purchase the needed medication.

Henderson said employees might also avoid purchasing medications needed to treat chronic illness, which is inconsistent with the county's recent disease management and wellness initiatives.

He said the co-pay structure is the most common method used for groups that cover prescriptions with a separate prescription benefit.

Co-pays are typically structured in tiers associated with generic, preferred brand, non-preferred brand and specialty. Henderson recommended $10 for generic, $35 for preferred brand, $50 for non-preferred brand and $100 for specialty.

He said the change to a co-pay plan would cost the county roughly $43,000.

"Being healthy, I think it's a good strategy," Hickerson said.

He asked if there was a way to build the cost into the program, voicing concern about the expense to the county.

Henderson said he could review the recommended co-pay amounts to see if they could be slightly higher, noting it needed to be affordable for employees.

"We want them to be able to get their medications," he said.

County employee Jim Massman said a factor not considered into the cost was possible savings on the medical side when employees stay healthy by taking needed medications.

"That's going to offset it to some extent," he told the commission.

Massman said he thought employees would see a co-pay plan positively because they would be paying a share and not the full amount up front.

"I think it's a minimal cost to the county," he said.

Commissioner Travis Becker told Henderson he wanted to see how much the plan has cost or saved the county after a year.