It's all part of my Autumn Almanac.

“From the dew-soaked hedge creeps a crawly caterpillar
When the dawn begins to crack
It's all part of my autumn almanac
Breeze blows leaves of a musty-colored yellow
So I sweep them in my sack
Yes, yes, yes, it's my autumn almanac.”

-The Kinks-

                                             Lyrics by Raymond Douglas Davies

Employer Group Waiver Plan Implementation

Skyrocketing drug costs are putting a tremendous strain on the GIC’s ability to offer comprehensive prescription drug and medical benefits.  According to the state’s Health Policy Commission, Massachusetts prescription drug expenses increased 13% per capita in 2014 and accounted for one-third of the 4.8% increase in total health care costs.  The opportunities to tackle rising drug costs are limited — driven by the introduction of new very expensive specialty drugs that have a wide audience of potential users and more oncology drugs coupled with enormous increases in existing drug prices.  More than half of our members are retirees. Medicare retirees use more than twice as many prescriptions as employees and non-Medicare retirees.

Last summer the GIC embarked on a complex project to implement a new prescription drug program for over 70,000 UniCare State Indemnity Plan/Medicare Extension (OME) members that is projected to produce significant savings to the Commonwealth and members of the plan.  Called EGWP (for Employer Group Waiver Plan), this is a group Medicare Part D Plan that also includes a “wrap” to close the gaps between a standard Part D plan and the members’ previous non-Medicare plan coverage.  It took a true team effort to ensure a successful and timely implementation of this program.

Highlights included:

Data Reconciliation: One of the most challenging aspects of the program was the required data match with Centers for Medicare and Medicaid (CMS) records.  The IT department generated monthly file exchanges beginning in June. Thousands of data discrepancies were worked through: spelling of first or last name, use of Junior or another suffix, date of birth, or totally different first names.  Through the Operations Department’s culling and outreach, the GIC achieved the cleanest files out of SilverScript’s (the new pharmacy vendor) entire book of business.  This also was the lowest number of errors for any of the sixteen CVS Caremark’s (the affiliated pharmacy benefit manager) January 1, 2016 EGWP implementations.  The GIC was also the largest transfer.

Changing and Improving Processes:  Due to federal government requirements, the GIC needed to accelerate the timeline to enroll retirees and their covered spouses in Medicare coverage.  The team took the opportunity to not only revamp the process, but also to improve it.  A customized form was developed that included a bar code for ease of data input and retrieval.  The IT department created a tracking system and screens for the GIC customer service units to answer member questions about the status of their “Turning Age 65/Retirement” mailing and application.  Additionally, the materials included with this mailing were overhauled to give members a comprehensive outline of their GIC Medicare plan options and costs. 

Comprehensive Communications Campaign:  The Centers for Medicare and Medicaid required that all members of the plan be offered the opportunity to opt out of the EGWP plan.  However, if retirees opted out they would not only lose their prescription drug benefits, they would also lose their GIC medical and mental health coverage. 

The GIC conducted a comprehensive outreach campaign prior to the required opt-out mailing to let retirees know they should not opt out of coverage.  This included:

  • A special edition of the fall For Your Benefit newsletter for retirees was devoted to the EGWP transition 
  • A home mailing with Frequently Asked Questions to all UniCare OME members two weeks before the required opt out mailing
  • Collaboration with the Retiree Association
  • Reviewing and editing multiple federally-required and difficult-to-understand communications
  • A home mailing to out-of-country members to let them know we would be switching them to UniCare Basic 
  • Updated employee forms to reflect the new retirement procedures
  • Communications to GIC Coordinators and participation in the Comptroller’s Payroll User Group meeting attended by over 100 Coordinators
  • Communications to municipalities for budget planning
  • Development of a new Turning Age 65 Frequently Asked Questions brochure that is distributed at health fairs and the corresponding FAQs on our website

As a result of the comprehensive communications campaign, no member opted out of coverage unless they had an extenuating circumstance. GIC Operations staff called these members to be sure that was the case.

Exemplary Customer Service: The Public Information Unit was the main point of contact for retirees who had questions about the EGWP program.  They answered over 10,500 EGWP calls over a six month period, helping members before and during the transition.  Although the GIC had put in place a wrap plan to provide a comprehensive prescription drug program similar to the non-Medicare option, due to formulary differences, some members experienced slightly higher out-of-pocket costs or the need to get a temporary 30-day supply of a maintenance drug before their 90-day supply could be filled.  The Public Information Unit provided outstanding customer service to the approximately 500 affected members and also worked with the vendor to resolve issues quickly. 

Outstanding Results

Three months after implementation, EGWP-related calls dropped to negligible levels, demonstrating the success of the implementation.

Despite well-publicized skyrocketing prescription drug costs, the new EGWP program is reaping huge savings for both members and the Commonwealth.  First year estimated savings will come in around $30 million total.  Lower drug costs were the largest factor leading to lower premiums: the UniCare State Indemnity Plan/Medicare Extension rates decreased by 7.2% effective July 1, 2016.  For retired teachers in the GIC RMT (non-municipal) program, the premium went down by 10.3%.

In addition to premium savings, very low income members can now access prescription drug premium subsidies.  Some members prescribed certain drugs are paying lower costs than they did under their previous prescription drug program.  Members can now receive their 90-day supply of prescription drugs at any participating retail pharmacy (retirees continue to have the lower mail-order copay at certain pharmacies, such as CVS Pharmacy and Navarro).  They can also now receive their prescription drugs at nursing homes and long term care facilities.

This information provided by the Group Insurance Commission .