Posted 12:55 p.m. Friday, May 19, 2023
The Group Insurance Board yesterday approved benefit changes for the State of Wisconsin Group Health Insurance Program for the 2024 plan year. Highlights of changes include:
- Expanded coverage of advance care planning and palliative care services for members with a non-terminal disease and/or survival of less than 12 months.
- Removed the expectation that physical, speech, and occupational therapies result in significant improvements for patients within two months of beginning treatment.
- Removed the required 30-day rental of infusion pumps for insulin, pain relievers, and other drugs prior to purchase of equipment.
- Increased flexibility for health plans to waive the requirement of prior authorization.
- Removed the requirement that members who change health plans during an inpatient stay need to move to a new in-network facility due to the change in plan provider.
- Provided coverage of scleral contact lenses when prescribed for the treatment of keratoconus and other similar rare conditions affecting vision.
The Board deferred approving a new pharmacy cost-savings program to collect available specialty drug manufacturer coupons on behalf of non-Medicare GHIP members and use them to offset member and GHIP program costs. The program would have offset members’ out-of-pocket costs by $1.8 million and generated $26 million in GHIP savings if it were in place last year.
The Board wants time to consider concerns raised by certain advocacy groups, review proposed legislation that may affect pharmacy benefits, and evaluate the impact of pharmacy claims experience on preliminary rates for 2024. This will be addressed at a special Board meeting prior to the regularly scheduled meeting in August when rates are approved.
In addition, the Board discussed current reserve estimates that are below the Board’s target range policy, due to less-than-expected investment earnings and higher pharmacy claims. Reserves are used to curtail health care premiums paid by members and employers.
The Board also approved:
- The actuarial valuations for the State and Local Income Continuation Insurance Programs, as of December 31, 2022. There will be a 10% reduction of the state ICI premium and a continuation of the local ICI premium holiday for the 2024 plan year.
- The following pilot programs for the 2024 plan year: Telehealth for the treatment of obesity, prediabetes, and type 2 diabetes; comprehensive care management and other services for members with medical and psychiatric conditions; digital monitoring of diabetes; doula services; and acupuncture for pain management. These programs are designed to provide better health outcomes and cost savings.
- Delta Dental of Wisconsin to administer employee/retiree-pay-all supplemental dental plans, effective January 1, 2024, through December 31, 2026, pending contract negotiations.
The Board did not approve other proposed medical and pharmacy benefit changes due to projected utilization and increased costs to the program. This included coverage of dietician and nutritional counseling for weight loss and weight-loss drugs. ETF will continue to monitor health outcomes and cost-benefit analysis for future consideration by the Board.
For More Information
Group Insurance Board May 17, 2023, Meeting Agenda and Materials