THURSDAY, Dec. 5 — Ingham County Commissioners are exploring a shift in prescription drug benefits for county employees as officials attempt to address concerns about hindered access to certain medications, including name-brand treatment for HIV and hormone-shifting drugs to facilitate gender transitions.
But any shift to enhance the county’s prescription drug coverage would almost certainly come at a higher cost, forcing commissioners to choose between trimming annual expenses and bolstering coverage for employees.
“We’re looking for a pharmacy provider that would provide a fix to this problem,” Commissioner Victor Celentino said. “We have to look at costs, but also whether it’s worth the expense for having a plan where employees can easily access the medicine they need. We have to balance cost effectiveness with employee needs.”
The commission’s County Services Committee met Tuesday to discuss options after multiple employees — including one living with HIV — brought forward concerns about name-brand treatment options being excluded from county coverage and the “hoops” they needed to navigate to eventually receive medicine.
“I fell victim to discriminatory prescription coverage and procedures that directly contradict the core values that Ingham County has laid out for me,” he told commissioners. “I would have to switch to a generic drug. Without that prescription coverage, I’m forced to use temporary assistance programs. … I’m here today to ask for help.”
City Pulse is withholding the employee’s identity in consideration of the cultural stigmas still attached to HIV.
After the county switched to a self-funded insurance pool earlier this year — and saved an estimated $2 million — all medication to facilitate gender transitions, as well as non-generic HIV treatment options, were listed as “excluded” through an ongoing contract with MaxorPlus, the county’s prescription drug provider.
Employees who request those “excluded” medications are typically rerouted to another provider — ARORx — to facilitate access to the drugs often at little to no added cost, according to County Controller Tim Dolehanty. But some commissioners still want to streamline the process and ensure the drugs are initially made available.
“We want to see what is out there,” said Commission Chairman Bryan Crenshaw. “We don’t know what else is out there. Another provider might offer easier access to these drugs. There may be extra costs, but we don’t know these answers until we look for them. We just want to ensure we’re meeting employees’ healthcare needs.”
Commissioners previously pointed to an “unconscious bias” against those living with HIV or the LGBTQ+ community embedded within the coverage plan. Some contended that any additional referral to another third-party prescription provider only represented an unnecessary obstacle for a subsection of employees.
Name-brand HIV treatment medication, as officials explained, is often behind the curve of constantly evolving research on the virus. Drugs that aren’t on the cutting edge of medical technology often include a host of negative side effects and can lend to substandard treatment for employees that are steered into using them.
And because the U.S. Food and Drug Administration has yet to formally approve any method of hormonal transition treatment for transgender patients, all medication for gender dysphoria is prohibited under the county’s prescription drug benefits as well. As a result, employees are entirely cut off from accessing them without some type of formal exception.
Dolehanty said the exclusion list is largely boilerplate language and represents the norm within the insurance industry. And if county commissioners want to find another provider with fewer initial exclusions, it would equate to increased costs shouldered through both county coffers and county employees.
“There’s really no way to know what the cost of another provider would look like,” Dolehanty said. “We could make adjustments, but it would be awfully tough to sustain higher costs with our other obligations. The system isn’t perfect and it never will be, but it looks like the commission will be exploring those options to address this.”
Commissioners are slated to search for another prescription drug provider through an RFP process beginning next year. In the meantime, Dolehanty has been tasked by the committee with further investigating the prescription access situation, determining why those medications were excluded and charting out solutions.
“I don’t think it matters that the prescriptions were ultimately filled,” added Commissioner Robin Naeyaert. “It’s great it was ultimately filled. What has gotten us here is the process it took to get that prescription filled. It’s cavalier to say it was ultimately filled when the process is still not consistent with the expectations of the county.”
As an added consequence for Ingham County’s prescription access issue, Ingham Community Health Centers this year was demoted to a “top performer” rather than a “leader” in the Human Rights Campaign’s annual Healthcare Equality Index. Officials attributed the diminished status exclusively to the newfound coverage gaps.
Additionally, the City of Lansing this week joined Ingham County in efforts to tweak employee health insurance benefits after the same access concerns were voiced by Lansing City Council Vice President Peter Spadafore. City officials said a search for a new, alternative healthcare consultant could begin as early as next month.
“We will not select a carrier that includes language that — for all intents and purposes — is discriminatory,” said Lansing Deputy Mayor Samantha Harkins. “Sometimes, with the high cost of drugs, there will be things that are not covered, but we’re not going to have something that includes this same list of exclusions for our employees.”