Additionally, Holy Cross Hospital-Davis will no longer participate in the Select Health Med, Select Health Care, and Select Health FEHB networks unless an agreement is reached by the end of the year.
According to Select Health, what this means for customers with affected plans is that after January 1, 2024, “Holy Cross Hospital-Davis will be considered out-of-network, and any services received at this facility may be denied or covered at a lesser benefit.”
If you’re an individual, family, or employer with Select Health, the company is encouraging you to find a new in-network facility to replace Holy Cross Hospital-Davis before January 1, 2024.
Select Health has offered the following guidance:
- Visit the Select Health online provider directory at selecthealth.org/facilities. Search by facility type and geography.
- For all other questions, please contact Member Services at 800-538-5038 weekdays, from 7:00 a.m. to 8:00 p.m., and Saturdays from 9:00 a.m. to 2:00 p.m. TTY users call 711. Member Services can help find an in-network hospital, such as:
- Intermountain McKay-Dee Hospital in Ogden, UT
- Intermountain Layton Hospital in Layton, UT
- Intermountain LDS Hospital in Salt Lake City, UT
In some situations, people on specialty medications could end up paying an additional $9,450 (individual) to $18,900 (family) out of pocket in 2024
If you’re a Select Health customer through a small employer or individual plan, there are important changes to Select Health’s RxCore five-tier formulary that you should be aware of. Beginning January 1, 2024, when Select Health members fill specialty medications at in-network specialty pharmacies, payments made using manufacturer copay assistance programs will no longer count towards their accumulators. This is set to affect Select Health customers in all states.
What this means is that if you use a drug manufacturer’s copay assistance card to help cover the cost of your medication, and you usually reach your out-of-pocket maximum early in the year, that will likely change. You will also likely end up paying more out of your own pocket for your medications. That’s because like several other health insurance companies that do not count manufacturer copay assistance towards your deductible and out-of-pocket maximum for prescriptions, Select Health is now following suit.
Here’s a short (not comprehensive) list of medications that may be affected:
List from: GoodRX
Even if you don’t see your medication on the list above, if you use are using a copay assistance card to help cover a portion of the cost of the your medication, we recommend contacting the provider of your copay assistance program to determine how changes to the Select Health RxCore five-tier formulary (the list of a plan’s covered drugs) will affect you.
Select Health says this change is being implemented to help manage the high cost of health care. In a recent agent alert, Select Health noted:
As we manage health care costs for all our members, we sometimes have to make difficult decisions about the drugs we cover and how we cover them. These changes are guided by evidence-based assessments and receive approval from our Pharmacy & Therapeutics Committee.
”This could have a major impact on the affordability and access to certain medications” according to Rebecca Yates, CEO and Founder of Ark Insurance Solutions. “Even if your copay assistance program card has covered the majority of the expense for your specialty medicines in the past, this will likely change in 2024. Worst case scenario, it could mean paying an additional $9,450 (individual) to $18,900 (family) out of pocket in 2024.”
Since the amount of out-of-pocket expense could increase by thousands of dollars in 2024, Select Health customers should be proactive in reaching out to the drug company’s copay assistance program to determine the amount of the annual assistance maximum. During the past 4 years, all other Utah health insurance carriers have implemented a copay accumulator or copay maximizer program.
Your drug manufacturer copay assistance program:
Contact the program (the phone number is often listed on your copay assistance card) for specifics on how this change will affect you. Specifically, you’ll need to ask what your annual assistance maximum (or cap) is.
Ark Founder and CEO Rebecca Yates reported Friday from the Utah State Capitol that S.B. 184 – Prescription Cost Amendments, was assigned to the Business and Labor committee in the house. That means it’s crucial to reach out to your representative to ask them to please support this important legislation.
Under current law, insurance companies are permitted to use copay accumulator adjustment policies to exclude copay payments/assistance provided by non-profits and pharmaceutical companies, so that these payments do not count towards a patient’s deductible or out-of-pocket-maximum. This leads to skyrocketing medical bills, and in some cases, patients not being able to afford needed medication.
Yates added, “Trying to address the cost of pharmaceuticals by adding financial burdens to our disabled communities is not only illogical, but also immoral. If they want to fix the cost of care and medications, they need to do it directly, not by trying to recoup it on the backs of those already burdened with poor health.”
Sen. Curt Bramble, R-Provo, is the chief sponsor of S.B. 184 – Prescription Cost Amendments, which would require an insurer to calculate any amounts paid on behalf of an individual towards the individual’s cost sharing requirement, and would require a pharmacy benefit manager to calculate any amounts paid on behalf of an individual towards the individual’s cost sharing requirement.
Unfortunately, the bill does have opponents who are lobbying against it. S.B. 184 will likely be voted on by Tuesday, 2/28, so it’s important to reach out now to one of the representatives on the Business and Labor Committee:
Below is an excellent op-ed authored by Jami Curtis that was included in Utah Policy today on this topic.