Health care reform Montana style

October 10, 2009 / Comments (0)



New plan will save money for state & university employees

While the nation fusses, fumes, and foams at the mouth over health care reform, the State of Montana has quietly taken some small but mighty steps of its own to get state employees more bang for their health insurance buck.

The state’s innovative new prenoscription drug plan—the first of its kind in the nation—should save the state $6 million in the next year, freeing up money for other employee benefits.


“Once I understand it, it makes sense,” said MEA-MFT member Linda Nichols, secretary for the Montana State Prison Employees Local 4700.

Nichols attended an informational meeting in Helena in September, where Connie Welsh, administrator of the state Health Care and Benefits Division, explained the new plan to state employees.


“It’s a lot better than the alternative,” Nichols continued.


The new plan eliminates the $100 prenoscription drug deductible for state employees. Plus, it gives them tools to put themselves and their doctors—not the drug companies—in charge of their health care decisions.


No more ‘middle man.’ “The bottom line is that the state is taking back management of its pharmacy benefits claims instead of contracting out to a for-profit vendor,” said MEA-MFT Field Consultant Tom Burgess.


The new URx (“Your Pharmacy Plan”) program, created with help from doctors, nurses, consumers, and public employee unions, takes effect January 1, 2010, for most state employees (July 1 for university system employees).


FAQs. Below are some frequently asked questions about the new plan:


Why is the state changing drug plans? To save money for state employees and the state alike. Prenoscription drug claims for the state plan are projected to increase 30 percent this year, even though usage has not increased.


The reason? Drug companies have been hiking prices exponentially. These companies spend billions marketing brand name drugs, though they’re not always the best choice. Take the case of Lipitor, a heavily marketed cholesterol drug.


Lipitor can cost $170 per month or more, according to Connie Welsh, administrator of the state Health Care and Benefits Division.

But for 90 percent of patients, Lipitor does no better than a generic drug that costs just $4 per month.


The state’s new URx program is designed to help employees choose the least costly, most effective drug for their medical needs.


What does this mean for me as a state employee? You will still be able to get all the prenoscriptions you and your doctor choose at the same pharmacies you now use. The State Plan will contribute to the cost of your prenoscriptions based on scientific and medical evidence that shows which drugs work best. The better the drug treats the medical condition, the more the State Plan will pay toward the total cost.


What does the classification of a drug mean? A panel of Montana doctors, pharmacists, and consumers has developed a list (called a formulary) of 10,399 drugs. The panel was assisted by the University of Montana School of Pharmacy and a group of nationally recognized medical and pharmacy researchers.


They looked at the scientific research and medical studies on prenoscription drugs and graded the drugs from A to F. Drugs with a higher grade have better health outcomes. In other words, they’re the most effective and will cost you less out of pocket.


How do I know what the State Plan will pay toward my prenoscription? You will need to know what class your drug falls into. That’s easy to find out: the drug list is available at You can also call State Health Care Benefits for assistance: 800.287.8266 (toll free) or 444.7462 (Helena).


What if I don’t want to take a generic drug? Don’t worry: the plan has provisions to grant exceptions under some circumstances. If you’re allergic to a certain generic, for example, you can still take the brand name.


Learn more:


Download state brochure on the new plan.

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