Florida Keys News - Key West Citizen
Saturday, September 14, 2013
School District mulls Rx plan

The Monroe County School District seems poised to sign a new contract with employee drug plan provider Envision Prescription Options -- but costs may be going up.

In addition, at least one School Board member has expressed reservations about the procedure that's led to a recommendation being made to the board.

At Tuesday's School Board meeting, board members listed to a presentation from Jeff Angello, a representative of benefits analyst Gallagher Benefit Services Inc., who explained available options to the local policymakers.

In total, six new bids have been examined by Gallagher in response to a request for proposals sent out by the district's purchasing department.

The options include the Envision 100 percent Pass Through plan, the Optum Rx Traditional, the Humana Pass Through, the Optum Rx Pass Through, Express Scripts Traditional, and the Humana Traditional. The new plan would come into effect on Jan. 1.

All bids were rated by Gallagher on a 3-point grading scale, using nine criteria, resulting in the Envision option coming out on top, with 1,076.04 points, and the lowest-rated being Humana's 980.35.

"Their scores were close, as far as numbers go," said district Employee Benefits and Risk Management Specialist Wanda Menendez. "They were ranked in all these different areas, and Envision came out with the highest recommendation. It's not just a mater of cost."

A recommendation to the board to go with the top scoring provider, Envision, will likely be put to a vote at the Sept. 24 board meeting

That recommendation will come from the district Health Insurance Committee, which met Aug. 28 to discuss the consultant's analysis of the various proposals, and will meet once more before Sept. 24.

That committee is made up of Menendez, Superintendent Mark Porter, and Executive Director of Finance and Performance Jim Drake, as well as members of the United Teachers of Monroe, union President Holly Hummell-Gorman, and Key West High School Principal Amber Archer Bosco, and will meet once more before the next School Board meeting.

"We reviewed the plans, and a recommendation was made," Menendez said. "It was voted on by us, and now it will be taken to board for approval."

Menendez said the new pill plan will probably be the same as the current one, though with possibly higher administrative costs from Envision that would be shared by the district and the employees themselves.

"It's really no different from their current plan," Menendez said. "We have 100 percent pass through with them."

Pass through means that the prices associated with the plans can be audited to determine the true costs, and mark-ups being charged by the companies.

Menendez added that, all things being equal, the cost of renewing the current contract, as Envision is essentially proposing, would be $4,000 greater.

"If our employees used exactly the same drugs and quantity of drugs in 2014 than they did in 2012, we would anticipate the cost would increase approximately $4,000 over the whole district, and that's because the administrative fee is increasing. If we were forced to pay an increase, the board is going to pay a portion and the employee is going to pay a portion. That's set by union contract."

On Thursday, reform-minded board member Ed Davidson of District 3 questioned the methodology that led the committee to arrive at their recommendation of Envision.

"The district committee that deals with insurance is composed primarily of folks who benefit from it, so they're primarily concerned with the benefits more than the cost," Davidson said. "It appears from Stuart Kessler's Audit and Finance Committee-authorized analysis that we might be able to get a $177,000 cheaper deal that would cost the employees $15,000 more in aggregate co-pays, so obviously if we could share more of the savings than the co-pay effect, everybody would be better off. The committee is just input. It's not binding. They don't make the decision, we do."

Still, Davidson did come down on the side of a pass-through plan such as the committee is suggesting to the board.

"It has to be a pass through," Davidson said. "The big boys, like Blue Cross and so forth, do not produce all the data, and so they cannot be accurately audited. We can't tell what their markup is. The pass-through ones do, and so you can accurately audit them and determine what the actual costs and markups are."

Davidson pointed to recent history with Blue Cross Blue Shied of Florida as a precedent.

"Last year, Blue Cross claimed they could provide the same plan for $500,000 cheaper, but they wouldn't provide the cost data so we could verify that. The problem is that it's hypercomplex, and confusing at best. And once again we're taking the word of folks who have had our non-competitively bid business of the School District for some 20 years."


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