VSEA Responds To More Of The DHR Commissioner’s Claims…

just the facts large

April 10, 2018:



VSEA has carefully reviewed Commissioner Fastiggi’s 4/9/18 memorandum line by line. Many of the comments are misleading regarding the drug plan changes the State will be implementing. It is important that members understand the truth behind the statements. VSEA members can figure out for themselves whether Commissioner Fastiggi’s memo makes them feel better or worse, but we thought a little light should be shed first.


Here is the analysis:


DHR/Fastiggi Writes: “I am writing to address the misleading communications from the VSEA that inaccurately characterize the changes to the pharmacy component of the state employees’ health plan…”


VSEA: DHR gave VSEA a list of “excluded drugs”, along with an email from their Deputy Benefits Director confirming that this was indeed the excluded drug list. Upon receipt, VSEA shared it with our members. No misleading communication there. DHR stated that the listed drugs would no longer be available in 2019. That is an accurate (not inaccurate) characterization of the situation. DHR has backpedaled since providing VSEA the list they stated was the official “exclusions list”. Fastiggi’s 4/9 memo to health plan members now has a link to a different “excluded drugs” list (bottom of Page 3). The new list is not the same as their original official list. It contains different drugs. That, Commissioner, would be an example of “misleading communications” and “inaccurately characterizing the changes”.


DHR/Fastiggi Writes: “Let me assure you that Vermont state employees will have access to the prescription medications they need…”


VSEA: Having “access to” is not the same as “getting”. As Bernie Sanders recently told a Congressional health care committee, “You keep saying people will “have access to” affordable health care plans. Does that mean they will get them? I have access to a $10 million house too, but I can’t afford it”. If your drug is on the formulary, you don’t need to worry about “having access” to it; you can get it. If it is removed from the formulary, you may have “access” to it but you may not get it. One is guaranteed; the other is not. If the Commissioner actually wants to assure state employees that they will get the drug they need, she can write language into the drug plan contract stating that all appeals will be upheld and state workers will actually get the drug they need. It appears, however, that all she wants to do is “assure you” that you can appeal when your drug is denied.


DHR/Fastiggi Writes: “The modest and responsible change to a standard national formulary is consistent with practice around the country, in other public plans, such as those offered to Vermont teachers, and will help curb premium hikes in the future.……”.


VSEA: We’ll pass on “modest and responsible” for now. As to the rest: (1) Fastiggi cites the drug formulary offered to Vermont teachers as something state employees should be happy to have. However, effective January 1, 2018 all Vermont teachers were switched from solid health care plans to high deductible health care plans with lower benefit levels. VSEA does not believe that a race to the bottom is good for state employees, and we uphold the solid health plans that VSEA has negotiated on behalf of our members over the years. (2) The State did not need to change the drug formulary to help curb future premium hikes. Last year our premium rates went up les than 2% (1.78%). The prescription drug component is the most stable part of the premium rate calculation. Drug costs have leveled off both nationally and in our plan. Our health plan has stable claims experience and we keep solid reserves to cover high claims costs. The spectre of premium hikes due to prescription drug costs is not borne out by the facts.


DHR/Fastiggi Writes: (There will be) “….sufficient time to…….transition to the standardized formulary with little disruption to any employee’s current pharmacy needs”.


VSEA: That is a claim that cannot be made. The State and Fastiggi have no idea what health issues members are facing, or how the disruption of having to change drugs will affect individuals or their family members. Allowing sufficient time for a transition has little to do with medical outcomes.


DHR/Fastiggi Writes: “The list of drugs released by the VSEA does not represent a list of banned drugs as was irresponsibly reported by the VSEA”.


VSEA: VSEA begs to differ. First, semantics. Definition of “excluded”: deny access to · shut out · ban · prohibit; remove from consideration; rule out; prevent the occurrence of; preclude. The drugs on this list will not be offered in the 2019 formulary, period. Call them banned or call them excluded – they are gone from the formulary.


DHR/Fastiggi Writes: “There will be a process to request an exception” in order to get one of the excluded drugs.”


VSEA: This statement confirms that the banned drugs are gone from the formulary. Members may “request” an exception, but it may not be granted. If it is not, the state’s appeal process is lengthy and laborious. There are three levels of appeal and it can take weeks. “Requesting” an exception is not the same as “obtaining” an exception.


DHR/Fastiggi Writes: “Please note, employees will be able to get medications they need…”


VSEA: This statement is misleading if not false. If a medication an employee needs is banned from the formulary, there is no guarantee that they can get that drug. All they will be able to do is file an appeal and hope they can get it. Appeals can take weeks and then be denied. Perhaps employees will be able to get the drugs that DHR or Express Scripts thinks they need, but there is no guarantee they can remain on the drug they are currently on if it is banned fro the formulary.

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