Wisconsin ‘High-Risk’ Health Insurance Program Changes Prescription Drug System
Wisconsin lawmakers say changes slated to take effect Jan. 1 will "make it easier" for the 11,800 members of the state's "high-risk" health insurance plan to purchase prescription drugs, the AP/St. Paul Pioneer Press reports. According to the AP/Pioneer Press, the Wisconsin Health Insurance Risk Sharing Plan, which offers coverage to individuals who cannot obtain private insurance because of preexisting medical conditions, in August adopted a new claims system that "forced" plan members to pay for prescriptions "upfront" and receive reimbursement. But an audit released Sept. 18 by the state's Legislative Audit Bureau said the system raised "special concern" for those "policyholders with high drug costs who do not have ready access to funds to pay the upfront costs." In response to the audit, the state plans to implement the following changes to HIRSP:
- Pharmacists will gain online access to members' deductible and coinsurance information.
- Policyholders will not be required to fulfill overall insurance deductibles before the plan starts paying drug claims.
- Plan members' coinsurance rates will be capped at $25 per prescription.
Also in the Audit
The audit also indicated that HIRSP had "overpaid almost 1,000 pharmacies" $5.5 million over two years, attributing the overpayments to the removal of program "cost controls" in 1998 to reduce pharmacists' billing confusion. According to the AP/Pioneer Press, state officials reinstated the cost controls in January 2001, prompting 160 pharmacies to leave the program until the state "developed [the] electronic processing system" implemented in August. Margaret Kristan, HIRSP director, said that the state's Department of Health and Family Services will begin efforts to recover $1.6 million of the overpayments in the "next month or two" (AP/St. Paul Pioneer Press, 9/20).
