UC drug plan change leaves employees without essential drug coverage

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During the first week of March, UC Davis microbiology professor Jonathan Eisen received a letter in the mail from the University of California, dated three weeks earlier, informing him that the type of insulin that he used to manage his type 1 diabetes over the past decade was no longer covered by his health insurance. Without coverage, the insulin would cost him more than $10,000 a year.

The change took effect Jan. 1, Eisen learned, when the UC system transferred management of its prescription drug benefits from one company, Anthem IngenioRx, to another, Navitus Health Solutions.

“Each Prescription Benefit Manager (PBM) uses its own formulary, which is a list of drugs covered by the plan,” the university explained in a notice posted in January on its website. “Although the Anthem IngenioRx and Navitus formularies are similar, there are differences that could affect your individual drug costs.”

With the switch to Navitus, Eisen’s insulin would be covered for a transition period ending March 31, after which alternative insulin would be covered. For Eisen, change is anything but trivial. “This drug literally keeps me alive every day,” he said. “It’s not something I can stop taking.”

Insulin is a hormone, made and released by the pancreas, which regulates the body’s metabolism and blood sugar levels. Without it, blood sugar rises, endangering the heart, kidneys and other organs. People with type 1 diabetes have a pancreas that produces little or no insulin. For several decades, diabetics have been using synthetic insulin, injected daily, to regulate their blood sugar levels.

While the discovery of synthetic insulin is celebrated as a medical miracle, it is not a one-size-fits-all solution. “Each diabetic needs to determine which balance of insulin — or insulins — to use,” Eisen said. Figuring this out can be a complicated process of trial and error that involves varying the timing, type, and amount of insulin injected after eating different types or amounts of carbohydrates. “The current protocol I use took me years to find,” Eisen said.

He wasn’t the only one to lose lifesaving drug coverage. After reading the letter on his insulin cover in early March, Eisen tweeted about it to his approximately 65,000 Twitter followers. Within minutes, other UC employees responded. Some had also lost coverage for their insulin, others for migraine medication or their child’s inhaler.

“I’ve received dozens of private messages from people facing this situation,” Eisen said. Some had already paid out of pocket for drugs previously covered by their insurance. Others, like Eisen, had spent hours on the phone with health care providers, pharmacy workers and Navitus representatives trying to find a solution.

This week, the university sent letters to affected employees to address the situation. “We are writing to acknowledge — and apologize — for the issues that many members of the UC community are having with Navitus Health,” said UC Vice President of Human Resources Cheryl Lloyd and Vice President UC Health executive Carrie Byington in the letter. (On Tuesday, Eisen posted a copy of the letter on his blog.)

The switch to Navitus was made, they said, after a formal bidding process and extensive review by UC Health representatives, human resources staff, faculty with pharmacy expertise and others. “Navitus has been selected as a partner capable of providing Unified Communications with the best flexibility, service and price,” the letter states.

The university, however, realized that the change posed problems. “Since UC’s transition to Navitus Health, we’ve heard from too many members who have been negatively impacted by this change,” the letter states. “Some members have had to switch prescription medications, have had to go through time-consuming authorization processes, and have experienced Navitus denials, causing unnecessary anxiety and frustration.”

The letter, which focused on the bad experiences UC employees had with Navitus customer service, explained that the company had faced staffing issues, which led to it not respecting the “performance guarantees” she had made in college. “We take these issues — and our responsibility to ensure that members of UC health plans have access to the prescriptions they need — very seriously,” the letter said, adding that human resources staff at the UC “has been in constant communication with Navitus” and was working to resolve the issues.

Some of the solutions promised this week by UC leaders include extending the transition period during which drugs no longer covered will be covered until the end of April, adding 35 new service representatives customer to Navitus staff, phone calls to help UC employees file calls to have their medications covered and “explore a concierge-style customer service model to ensure UC members receive the dedicated support that they need”.

In a statement to The Enterprise, UC media relations director Ryan King acknowledged the situation and said the university had nothing to add that was not in the letter sent to employees this week. week. On Tuesday, Navitus told The Enterprise that he could not comment on “individual employee coverage situations,” but that he was “working with the University of California to provide the highest level of customer service to their employees and to make sure they have access to the drugs they need.”

Neither Navitus’ statement nor the university’s letter included a commitment to cover drugs, like Eisen’s insulin, that aren’t on the company’s formulary. Eisen appreciated the apology from UC leaders, he said, but remained frustrated. The university “has rolled out something that has seriously harmed many UC employees,” Eisen tweeted on Tuesday. “It remains to be seen whether anything will improve or not.”

— Contact Caleb Hampton at [email protected] Follow him on Twitter at @calebmhampton.

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