DHR Commissioner Argues Semantics

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April 9, 2018:

 

 

Many VSEA members received yet another memorandum of explanation from DHR April 9, seeking to tamp down the firestorm created by an Rx drug list that DHR’s Benefits Director provided to VSEA last week. The memo labels VSEA’s use of the word "banned" as "irresponsible," but you
be the judge…

Here’s the sentence from DHR’s memo April 9:

"The list of drugs recently released by the VSEA does not represent a list of banned drugs as was irresponsibly reported by the VSEA."

Now here’s what DHR’s Benefits Director wrote to VSEA last week in a cover email attached to the infamous list of 170:

"The drugs indicated on that list are actually “excluded” from the formulary, so they would be replaced by a drug that is currently on the standard formulary where applicable." 

Couple of things to note here:

  1. The use of "standard formulary" versus "customary formulary," which VSEA will be explaining very soon; and

  2. The words "where applicable."

Dissecting A Few More Lines From DHR Commissioner’s 4/9 Memo

 

Commissioner Fastigi wrote on 4/9:

"If your medication is determined to be “excluded” as of January 1, 2019, you will be contacted directly by the PBM. If your doctor determines that an excluded medication is most appropriate, your doctor will be able to coordinate with the PBM and request an exception.“

 

&

 

"Every medication that is currently taken by State employees that is not a part of the standard formulary will have a clinical or therapeutic equivalent."

 

Okay, here is what the DHR Commissioner is really saying:

  • “Excluded”: The medication is not available under the plan.
  • “PBM”: An out-of-state corporation that is unaccountable to anyone but the State, and that will decide which medications you can be prescribed.
  • “Clinical or therapeutic equivalent": A different drug or therapy than the one your doctor prescribed, that may or may not be as effective. This term has whatever meaning the out-of-state corporation assigns to it.
  • “Request an exception”: A so-called appeal to an employee of the out-of-state corporation

 

What Ms. Fastiggi’s written words translate to in real terms:

An out-of-state corporation will decide what medicines you can take, not your doctor. If you and you doctor disagree, you can “appeal” to an employee of the out-of-state corporation to overrule his or her own employer, and whose decision is final. If that doesn’t work, you will be required to use a different drug, which may or may not be as effective, or to pay full price out of pocket for the drug your doctor prescribes.

 

As this debate continues, remember too that in bargaining, the State wouldn’t budge from its position that the Scott Administration be sole decider when it comes to:

  • What prescription drugs state employees will be offered; and
  • The quantity state employees can receive.

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