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Department of Employee Trust Funds
Revised May 26, 2017

GIB Selects Pharmacy Benefits Manager,
Raises Concerns About Possible Premium Increases

At its regularly scheduled meeting on May 24, the Group Insurance Board (Board) approved issuing a notice of intent to award a contract to Navitus Health Solutions (Navitus) as the pharmacy benefits manager for the State of Wisconsin Group Health Insurance Program, starting January 1, 2018. Navitus is the current PBM under a contract that expires in December.

In addition, the Board discussed at length the status of the proposal before the Joint Committee on Finance (JCF) to change the group health insurance program to a self-insured model in 2018.

Segal Consulting, the Board’s consulting actuary, reported an estimated 10.4% statewide average premium increase for 2018 under the current fully insured model, based on recent data submitted by the participating health plans.

The Board expressed concerns about the potential level of cost shifting to members in order to achieve the more than $60 million savings in the state budget if the JCF rejects the self-insured contracts. (See Group Insurance Board Letter to JCF.)

The Board also approved the following minor health benefit changes for 2018, as outlined below:

  • Medication Therapy Management (MTM): MTM services will be expanded to all participants. This is a type of medication counseling provided by pharmacists.
  • Uniform Dental Benefit: Dental benefits are administered by Delta Dental. The following changes align with dental benefit industry standards and will not affect 2018 premium amounts:
    • Reduce bitewing x-ray frequency to once per year for most members
    • Increase coverage for sealants to age 19
    • Add coverage for medicament (a topical filling alternative; sometimes necessary, but rarely used)
    • Add evidence-based integrated care benefits for specific health conditions

Highlights of other Board action:

  • Open Enrollment: The It’s Your Choice open enrollment period for 2018 was set for October 2-27, 2017.
  • Medicare Advantage: The Board approved procuring one or more Medicare Advantage vendors for services to begin in 2019. The goal is to expand Medicare offerings with lower monthly premium costs.
  • Disability Programs: The Board approved actuarial valuations for the State and Local Income Continuation Insurance (ICI) Programs and Long-Term Disability Insurance Program, and approved changes to eligibility requirements for the local ICI plan.
  • Wellness Premium Differential: The Board approved implementing a premium differential for participating in the Well Wisconsin Program, beginning in 2019.

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