Almost 18 months after the Reno County Commission declined to consider contracting with a pharmacy management program promising to lower prescription drug costs, the board reversed course.
The commission last week unanimously approved contracts with health insurance consultant USI and Overland Park-based Tria Health.
The first time around, in November 2020, interim County Commissioner Mark Steffen opposed the plan, and Commissioner Ron Hirst joined in his objections.
Steffen cited concerns that consultants would push drugs on employees that were less effective to save money. Hirst noted that some of the costs for routine prescription items, such as diabetes test strips, appeared to be much higher in the plan details presented than local pharmacies could provide, questioning the program’s value.
Rick Beins with USI Insurance Services and Reno County Human Resources Director Helen Foster presented both plans on Tuesday.
The first, called Payer Matrix Infusion Patient Assistance Program, is designed to reduce infusion drug costs by offering patients assistance in finding the drugs and creating alternate funding for them.
It reduces the amount the health plan pays for these drugs and allows the member to receive infusions at low- or no cost.
The second, called Tria Health Disease Management Program, targets members with multiple high-risk chronic conditions and works to help them manage those conditions through one-on-one interaction with a pharmacist.
Beins explained that Tria works with members to assist them in coordinating medications and ensure they are taking medications as prescribed.
The company also is able to help members manage the costs of maintenance drugs, which then saves the plan money.
It particularly targets those with chronic conditions who are taking four or more prescription drugs, Beins said, because they historically have the highest costs and greatest potential savings.
The conversations intend to see how patients are feeling, whether there are any drug interactions, and explore better treatment regimens.
With the individuals often going to different specialists for their various conditions, those specialists or their primary physician often don’t know all the drugs the individual has been prescribed or how the patient is reacting to them, he said.
“If the drug doesn’t make someone feel well, they often won’t take it or at the level prescribed,” Beins said. “They’re just throwing it in the trash.”
Or if they are prescribed five medications, they may be only filling three because it’s too expensive. But not taking the prescription medications can make their chronic condition worse and cost more in the long run.
The contracting pharmacist will make recommendations on any changes to the patient and his physician simultaneously.
Starting in October, the company will reach out to about 190 members on the county’s health plan who have one or more chronic conditions and who accounted for $1.2 million of the plan expenses last year. Their goal is to sign up at least 25% of them.
The plan will cost the county $5 per employee. Those costs include providing incentives for people to sign up, such as gift cards or waiving out-of-pocket costs.
Officials estimate the plan will save the county at least $50,000 in the first year, and the county is guaranteed at least $21,000 in savings. If everyone who qualified enrolled, the savings are estimated at more than $230,000.
Commissioner Ron Sellers noted the first time the board heard the proposal in 2020, there was some confusion over whether it would take business away from local pharmacists.
Hirst said he sees the program as adding “another layer” to getting healthcare, and those local pharmacists “do a good job in looking at prescriptions to see if one counters the others.”
“I understand people may see two or three different doctors, but you buy your prescription normally from your own pharmacist, and they’re pretty well trained to know what drugs are in regard to effects on one another,” Hirst said.
Hirst said he was willing to go forward with the program, “but I want accurate records from your company showing that” projected savings and for the county to receive a report back in six months.