Faced with rising prescription drug costs, consultants for the Oregon Public Employees Benefit Board gave its directors a list of recommendations at this month’s meetings that could better align PEBB’s benefits with the private sector.
Consultant Virginia Rivas recommended eliminating coverage of fertility drugs, increasing the copay for high-cost speciality drugs at Kaiser to $100 and making all drugs have at least a $1 copayment except where prohibited by the Affordable Care Act.
Her ideas were met with scepticism by the labor representatives of the PEBB board, including Stacy Chamberlain, who doubted the value of $1 copayments and wanted more studies about the cost of fertility drugs and the effect of a lifetime cap before she could support curtailing their availability.
The consultants said that fertility drugs are not only seen as an optional medical care, but pregnancies that result from these drugs are often much more complicated than natural births.
The consultants also took a look at emergency department utilization and found that a third of the claims were for non-emergency ailments like headaches, nausea and urinary tract infections.
Non-emergency use of the emergency room was highest among college-age adults ages 19 to 24, whose utilization was 75 percent higher than children and other adults -- possibly because these adults have parents picking up the cost of their insurance, but they have left home without yet finding a primary care physician in their new community.
Emergency room use was also much higher in rural, Eastern Oregon than in the Willamette Valley, with utilization rates in Umatilla County more than twice those in Benton County.
The emergency room is typically the only place to receive care after-hours in Eastern Oregon, while there are ample choices in cities like Corvallis, where Samaritan Health offers urgent care clinic hours until 8 p.m. weekdays and until 6 p.m. on Saturday and Sunday.
The board did not take action on any of the consultants’ proposals, but the suggested changes may appear again at future meetings or when the board approves the medical and pharmaceutical benefits annually.
