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Politics

State Workers to See Insurance Changes

May 4, 2019 - 7:30am
Paul Renner
Paul Renner

Changes could be coming to the state employees’ health insurance program under a bill passed Friday by lawmakers.

Some changes --- including the use of a drug formulary --- could take effect next year if the bill is signed into law by Gov. Ron DeSantis. Other changes won’t take effect until 2023.

The measure (HB 1113) would require the state Department of Management Services to analyze its current contracts with health maintenance organizations, preferred provider organizations, and prescription drug programs and develop a plan to procure new contracts for benefits beginning in 2023.

Senate bill sponsor Manny Diaz Jr., R-Hialeah, said the state currently procures PPO contracts every five years, HMO contracts every three years and pharmacy benefit plans every three years.

“The lack of coordination is inefficient,” Diaz said.

The analysis and recommendations must be submitted to the governor, the Senate president and the House speaker no later than Dec.  1.

The measure passed the House by a 105-2 vote on the final full day of the annual legislative session.  It cleared the Senate hours later by a 37-1 vote. Opposing the bill were Rep. Anna Eskamani, D-Orlando, Rep. Margaret Good, D-Sarasota, and Sen. Gary Farmer, D-Fort Lauderdale.

Sen. Bill Montford, a Tallahassee Democrat whose district is filled with state workers, pressed Diaz about some of the changes to the state employees’ health program.

“I want to make sure I know what I’m doing when it comes to state employee benefits,” Montford said. “This is new. Has it been discussed in any of our Senate committees before?”

Diaz acknowledged that the Senate had never discussed the proposed changes, which were a priority of the House.

The bill would authorize the state to limit the number of HMOs in the state program and allow for the plans to be competitively procured on a regional basis. The change is significant because more than half of the people enrolled in the program --- or 53 percent --- chose to enroll in an HMO.

The bill would authorize the Department of Management Services to develop rules related to the regions. Those rules would have to be ratified by the Legislature before taking effect.

The measure also would wipe out a two-decade prohibition on the state establishing a prior-authorization or formulary program for employees. Generally, a formulary is a list of prescription drugs covered by insurance plans. If the change is signed into law, the state must put in a formulary that would allow the program to stop paying for certain drugs, although the plan would allow physicians to order drugs if medically necessary.

House sponsor Paul Renner, R-Palm Coast, said the establishment of the formulary is expected to save $40 million.

The measure would also allow state workers to obtain drugs from Canada under an importation plan pushed by DeSantis.

Florida offers health-insurance benefits to employees, retirees and their dependents. Economists in March projected enrollment in the program at more than 179, 000 people. The costs of providing benefits are significant, with total expenses for the coming year expected to exceed $ 2.8 billion. Of that, $780.9 million is spent on prescription-drug claims, excluding money spent on pharmacy benefit managers.

And the costs are expected to jump in the future. Economists in March predicted the costs for prescription drugs would increase to $885.6 million, excluding pharmacy-benefit manager costs, in fiscal year 2020-2021 and would top $1 billion in fiscal year 2021-2022.

Comments

Does anyone really believe that Republicans are going to make healthcare or health insurance better or more beneficial to the general public? Even for their own constituents or their partisan base? Ha, ha, ha!

OOPS!!!! SORRY - SURE IS MONDAY!!! OK, then, Billy Boy, well, you know how I feel and how your constituents feel about this issue. I didn't realize this was a HB and not gone through the Senate. PLEASE DO THE RIGHT THING AND DO NOT LET US DOWN!!!!

So, if I'm reading this correctly, our representative here in Tallahassee, Bill Montford, voted FOR this bill???? HE WHO WE STATE WORKERS HAVE REPEATED VOTED INTO OFFICE IS ABOUT TO TOSS US BACK 20 YEARS IN TIME??? To a time when we had to get preauthorizations for certain medications, medical procedures and specialized medical professionals which sometimes took weeks!?!?!? I'm sorry Billy Boy - next election, you don't get my vote. And I'm sure you won't be getting a lot of my friends' votes either.

WILL THESE PROPOSED "CHANGES" APPLY TO STATE REPRESENTATIVES & SENATORS (AND THEIR STAFF MEMBERS) AS WELL ?!?!?

Yes!

Bill, So when is the legislature going to screw the state workers and take away the money you said would go to their salary if they chose a lower cost plan? When are you going to screw the state workers who have to keep the same coverage they currently have or go broke? Or go broke paying for it because the average state worker makes only $45,000 a year - after mortgage and college tuition, doesn't leave much for greatly increased health insurance costs? Keep in mind, state workers are not like legislators who can take off 4 months from their jobs to play in Tallahassee - we are not millionaires who can afford even a $100-200 hike without it hurting... We are not getting sweetheart deals elsewhere - I recall a legislator who thought his employer was the payroll company that was sending him money from an unknown employer... Average salary $45,000 - $3,750 - and that is before taxes and 3% to FRS and $200 to insurance (a great deal) but even a modest mortgage, a small car payment and prepaid college payments put us living month to month.

The monthly cost of health ins and dental insurance for retirees is astronomical !! This needs to be lowered. When will this be looked into!

I couldn't agree more. It was an eye opener when I retired due to disability. That tiny health insurance subsidy is a joke when you are paying $1,500 a month for health insurance for you and your spouse. Someone needs to do something!

Prior authorization is ridiculous too. Review the programs, yes, but don’t go back to methods that only made health harder for members to receive. Gov DeSantis - VETO

Formulates mainly allow the pharmacy benefit manager to cut deals and get kickbacks beneficial to themselves, while harming patients. People on heart, diabetes, epilepsy, mental health, etc. medication, are required to take what is on the formulary first, and see if it works. They are only allowed to get an off formulary medication reccomendationed by their physician if the formulary medication first fails, which can mean hospitalization, injury and death.

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