The new federally-funded “high-risk” pool for those denied with pre-existing conditions will start in September, as announced by California’s Managed Risk Medical Insurance Board (MRMIB) and reported by Sandy Kleffman at the Contra Costa Times. Her article includes projected premiums for the Bay Area.
Our Director of Administrative Advocacy, Elizabeth Abbott, was at the MRMIB meeting last week. She reports that they dealt with two items:
* Drug Benefit Design of the Pre-Existing Condition Insurance Plan (PCIP). MRMIB staff proposed a four-tier enrollee co-pay system under the new program as follows:
Brand-name drugs on formulary–$15
Brand-name drugs not on formulary–$45
Special drug regimen drugs that also require prior authorization and step therapy–$15
Board member Sophia Chang commented that she believed $45 for a co-pay was too high; she recommended that it be reduced to $30. The board approved the co-pay structure with Ms. Changs adjustment.
* Initial Designation of Vendors for Negotiation of Contract Terms. The board announced that they were entering into negotiation with two companies, Maximus and HealthNow. Lesley Cummings asked for representatives from each company in the audience to stand. The board asked for comments from the audience.
We’ll provide more updates about the PCIP when we get them…