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Department of Employee Trust Funds
July 13, 2016

Membersí Costs to Decrease for Insulin

Members in the state’s group health insurance program will see a significant decrease in their out-of-pocket costs for insulin beginning next month. ETF announced this drug formulary change at the Group Insurance Board meeting this week.

The change is a result of ETF researching the impact of the $35 increase in cost-sharing from 2015 to 2016 and overall concerns about insulin adherence. The preferred insulin products listed below will be moved from cost-share Level 2 (20% coinsurance with a $50 maximum) to cost-share Level 1 ($5 copay) on the Navitus commercial and MedicareRx formularies, effective August 1, 2016.

  • Lantus
  • Levemir
  • Novolin
  • Novolog
  • Tresiba

ETF and its pharmacy benefit manager, Navitus, analyzed insulin utilization data for years 2013-2015 and compared to current use. In 2016 fewer members are using insulin and there has been almost a 9% decline in the number of prescriptions filled. The decline in insulin use likely reflects a mix of both members who are rationing their insulin or have completely stopped use, concluded Jeff Bogardus, Manager of Pharmacy Benefit Programs, in a memo to the GIB.

Of course, there is also medical cost savings resulting from adherence to an insulin regimen. The associated medical costs from even moderate non-adherence could be $2 to $9 million, according to ETF research.

GIB Meeting Highlights

  • The GIB received an update on several Requests for Proposals.
  • The GIB approved Uniform Benefits changes for 2017 related to nondiscrimination on the basis of gender identity and other requirements for accessibility and limited English proficiency under new federal regulations of the Affordable Care Act.
  • The GIB approved premium changes for optional dental plans (Anthem DentalBlue, EPIC Dental Wisconsin, EPIC Benefits+), effective January 1, 2017, as recommended by ETF and the board’s actuarial consultant, Milliman.
  • The GIB voted to enter into contract negotiations with The StayWell Company, LLC for wellness and disease management services.
  • New GIB officers were elected: Michael Farrell – Chair and Herschel Day – Secretary.

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