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State employees, teachers poised to lose name-brand prescription coverage

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30,000 state employees, teachers poised to lose name-brand prescription coverage under state plan

More than 30,000 state and public school employees received letters this week informing them their medications will no longer be covered under the state’s prescription drug program as of July 1 โ€” the results of an effort by state leaders to save money.

A little-known board comprised of 14 state government leaders voted in August 2021 to make the changes to the prescription plan, according to meeting minutes. A spokesperson for the Mississippi Department of Finance and Administration said the change was made after COVID-19 caused an increase in costs. The change will save the state an estimated $15 to $18 million, according to DFA.

Earlier this year, lawmakers appropriated $60 million in American Rescue Plan Act to the plan to offset COVID-related losses. 

Almost 197,000 state employees, dependents, spouses and retirees receive state health insurance . The health benefits are administered by Blue Cross & Blue Shield of Mississippi, and CVS Caremark is the pharmacy benefit for the prescription drug program. 

โ€œThis is a way to curb those costs and continue to provide excellent coverage to state employees,โ€ DFA spokesperson Marcy Scoggins said in an emailed statement. โ€œAn external advisory board of and pharmacists recommends to CVS Caremark what (medication) substitutions are . In the majority of cases, the substitute has the same efficacy at a lower cost.โ€

But some covered by the plan don’t believe the substitute medicine CVS Caremark suggested for them will work and feel that the state is inserting itself between them and their doctor.

One school administrator, who did not want her name used because of her employment, received a letter about medication she began taking several months ago for a thyroid condition. Her plan would no longer it beginning July 1, the letter from CVS Caremark and DFA stated. 

The medicine, Armour Thyroid, costs about $100 a bottle. She was previously paying a $25 copay. 

โ€œWhen they change medicines like that, you have to start the process all over and go through, โ€˜Well this dosage is not enough, this dosage is too much,’ and have your levels drawn every so often,โ€ she said. 

She said she doesn’t understand why anyone besides her doctor is dictating what medicine she should take.

โ€œI’m just aggravated. It’s like they think they know better than what my doctor knows,โ€ she said.  

A teacher, who did not want her name used in a story for fear of retribution, first received a notice from CVS Caremark dated May 11 that Ozempic, her medicine for insulin resistance, will no longer be covered. The company wrote that โ€œ… starting July 1, 2022, you’ll have to change to a preferred medication.โ€

The preferred medicine listed was metformin, but she has already been taking that medication for nearly a decade, she said.

โ€œOn metformin alone, we weren’t having any โ€ฆ so (the doctor) said, โ€˜Let’s try this,’ and it was like magic,โ€ she said, referring to the once-weekly injectable Ozempic.

The retail price for the drug is around $1,000. With insurance coverage, the teacher currently pays a $25 copay. 

After talking to her doctor about submitting a prior authorization form โ€“ which the company could then approve or deny and continue covering the Ozempic โ€“ she got another letter the following week.

โ€œStarting July 1, 2022, there will be a limit on the amount of medication that your plan will cover. Once you reach the limit, you will have to pay the entire cost for additional medication which exceeds the limit,โ€ the May 17 letter stated. 

The limited amount covers what she takes, but she says she’s still a bit confused. 

โ€œI’m scared that they will jerk the rug out from under me mid-year and send another letter saying my medication won’t be covered,โ€ she said. 

An employee at the of Mississippi Medical Center, who also did not want her name used because of her job, has been using Synthroid for 10 years since having her thyroid . She’s tried the generic that CVS Caremark has suggested for her, but it doesn’t work. 

โ€œWe tried all different types of replacement hormones and different doses, and I’m now stable on one, and I don’t want to change again,โ€ she said. โ€œIt just seems flippant to me that they assume everyone can switch from Synthroid to the generic.โ€ 

She said she plans to try to qualify for a special savings program with the company. If that fails, she plans to to a friend whose doctor orders the drug from a Canadian pharmacy at a less expensive price.  

The last time similar changes were made to state employees’ prescription coverage was in 2019, according to DFA. DFA did not answer follow-up questions from Mississippi Today about how many people were affected and the amount of money saved that year.

The state health insurance plan’s reserves have dwindled from $274 million in 2015 to $113 million in 2020, according to a presentation made by Cindy Bradshaw, state insurance administrator, to the Senate Education Committee in September 2021.

Drug claims have increased every year in that same time period except for one, with the most recent increase of 5% occurring in 2020.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Mississippi News

Mississippi sees 5th largest increase in fatal crashes: study

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www.wjtv.com – Garret Grove – 2024-11-02 12:25:00

SUMMARY: A recent study highlights a troubling rise in road fatalities in Mississippi, with a nearly 31% increase in fatal accidents from 2012 to 2021, ranking it fifth highest in the country. The reported a spike during the 2024 Labor Day , responding to seven fatal crashes resulting in 15 deaths, to only three crashes and six deaths in 2021. Additionally, a 2023 showed Mississippi had the highest per capita fatal crashes during the Christmas period. Young drivers are particularly affected, as Mississippi ranks fifth for teenage driving fatalities nationwide.

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Mississippi News

Vicksburg man charged with assaulting woman in domestic dispute

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www.wjtv.com – Kaitlin Howell – 2024-11-02 11:33:00

SUMMARY: In Vicksburg, Mississippi, a domestic assault led to the hospitalization of a man and woman on November 2. were alerted by Merit Region after a 28-year-old man, Daron Evans, arrived with a stab wound. Authorities dispatched to the scene found the woman, who had also been assaulted. After receiving treatment, Evans was and charged with aggravated assault domestic violence; he is held without bond until his court appearance. The woman is in stable at the of Mississippi Medical Center. An investigation is ongoing.

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Mississippi News

Cloudy and humid weekend – Home – WCBI TV

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www.wcbi.com – Sadie Morris – 2024-11-02 10:13:00

SUMMARY: In Columbus, Mississippi, humid and cloudy weather is expected, with temperatures remaining above average in the lower 80s for the upcoming . Rain is forecasted for Election Day on Tuesday, continuing into the week with isolated showers likely. This Saturday will see patchy fog in the morning, clearing by midday, with a high around 80 degrees. Sunday will bring similar humidity, with a high in the lower 80s and mild overnight lows in the mid-60s. Throughout the week, expect persistent clouds and humidity alongside mild temperatures.

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