Changes to Drug Coverage for WiseEssentials Rx and WiseAdvantage Members

Prescription bottleYou may have seen reports in the news about changes to drug coverage for LifeWise members. We wanted to give our members the facts about what’s really happening.

Two of our plans, WiseEssentials Rx and WiseAdvantage, currently offer generic-only prescription drug coverage. We have been selling these plans for a number of years and we know that they are popular with our members.

WiseEssentials Rx is currently the only individual plan available in Washington that combines the lower monthly rates of a catastrophic plan with the added benefit of generic-only drug coverage. This is far and away our most popular plan, with over 45,000 members since we started selling it in late 2009. Other plans of this kind in Washington have no drug coverage at all.

New Rules

The plans were previously accepted by The Office of Insurance Commissioner (OIC), which regulates health plans in the state. However the OIC recently decided that effective August 2012 they will no longer allow any health plans in Washington to offer generic-only drug coverage.

We are disappointed that the OIC has chosen to remove this popular option from the marketplace. Feedback from our members indicates they appreciate an affordable coverage option that includes some level of pharmacy benefits when few plans give them that option.

What Does this Mean for WiseEssentials Rx Members?

Our WiseEssentials Rx plan will no longer be available after July. Adding brand-name drug coverage to this plan would have resulted in a substantial rate increase and we decided that this is a choice our members should be able to make themselves.

If you are a member of this plan you will have the option to move to any of our other plans without having to undergo any kind of health screening. You can select a plan that has both brand and generic drug coverage or one that has no drug coverage. If you are a member of this plan you will receive a letter in the mail soon outlining your options in more detail.

How Will this Affect Other LifeWise Plans?

Our WiseAdvantage plan will continue to be available and we will include both brand-name and generic drug coverage starting August 1. We will write to members of this plan soon with more information.

Other plans, including WiseEssentials 25 and WiseEssentials Copay, are not affected by this change. LifeWise members who do not have drug coverage will still benefit from our discount pharmacy program which gives them savings of up to 18% on brand name drugs and up to 50% on generic drugs.

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About LifeWise Health Plan of Washington

LifeWise Health Plan of Washington is the leading health plan for individuals in Washington state, serving more than 100,000 members. LifeWise offers individuals competitive plans that engage our members to successfully manage their health. LifeWise is committed to providing its members peace of mind about their healthcare coverage and has been serving the health insurance needs of individuals in Washington state since 2002.

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14 Comments on “Changes to Drug Coverage for WiseEssentials Rx and WiseAdvantage Members”

  1. airfoil Says:

    It is deeply disappointing that Insurance Commissioner Mike Kreidler would make a crassly political decision to disallow LifeWise Health Plan of Washington and other insurers to offer generic-only prescription drug coverage.

    My family relies on this coverage to provide an expensive ($160/month) generic drug for our young son. As of August, this decision will force us to either endure a very, very significant cost increase for a new, more expensive plan, or forego this needed prescription altogether.

    Commissioner Kreidler’s decision has served only to remove an important choice from consumers. LifeWise and the other insurance companies in this state offer a variety of plans that include brand-name drugs. Our family made a specific choice to take advantage of a plan that worked well for us. There seems to be no harm in allowing an insurer to provide an additional option for generic-only coverage.

    Instead of helping consumers, Commissioner Kreidler has decided to greatly harm nearly 50,000 of them.

    Perhaps I misunderstand the role of the Office of Insurance Commissioner. I thought an important mission of this office was to protect consumers. I might respectfully suggest that Commissioner Kreidler revisit the current mission statement of the OIC. Removing choice, and inflicting harm on consumers does not seem to fit into any definition of “protect” with which I am familiar.

    I would strongly recommend anyone affected by this harmful decision ask Mike Kreidler why he feels imposing a dramatic increase in costs on consumers is helpful: Ask Mike at http://www.insurance.wa.gov/about/ask_mike.shtml

    Reply

    • Chris Says:

      I completely agree with the previous comment. Below is a copy of my message to Mike Kreidler:

      Dear Commissioner Kreidler,

      Please reverse the OIC decision to disallow generic-only prescription drug coverage. The impact of this decision will be to price our family and many others out of receiving ANY prescription coverage. This decision has taken away an important and low cost insurance option. I thought everyone these days believed in giving people choices? What choices will we have now due to your decision? It appears it will either be to pay a significantly higher insurance premium, which we cannot afford, or to live with NO PRESCRIPTION COVERAGE.

      Sincerely,

      Reply

    • brenna Says:

      I agree 100%, Mike is only hurting all of us who need drug coverage and are ok with a generic only plan! How is it ok for him to choose for all of us???? What does it hurt to leave this option out there????? So I am an RN that takes care of everyone else at work but can’t afford to take care of myself???? Now more people will go to hospital with no coverage to get their illnesses temporarily taken care of and cost us all more in the end!!!

      Reply

      • airfoil Says:

        Yes – this is a completely senseless regulatory move that serves only to harm consumers. It should be the job of the OIC to ensure there are as many options available as possible – not work to remove options and dramatically increase costs. It will be interesting to see how many of the 50,000 consumers affected by this foolish decision will simply be forced to forego prescription coverage entirely.

        If this is the OIC’s idea of helping consumers, it seems time to question either the mission of the office – or perhaps the person who holds it.

    • OurFamily Says:

      This is so true, I don’t understand, realizing the huge MISTAKE he has made, putting peoples lives in jeopardy not to mention the financial burden, why he can’t negotiate with our carrier in an effort to retain generic coverage. Nothing! It’s the innocent consumer that is being punished and for what? Being responsible? Taking care of our families?, Not living off the Government? All who were on generic only coverage did so because they made the choice to do so. What was he thinking? He’s pathetic.,Passes the blame, actually blames this on poor decision making on lifewise”s part. He doesn’t get it. Had our plan added the branded drug benefit with generic only, we wouldn’t have any health coverage cause we couldn’t afford it. And that is exactly what is going to happen in the “Great Year Of Insurance Reform 2014″ Shame on you OIC. Our prescription cost are $500.00 or more a month now. versus a few $15.00 copays. No PAP available. What now? what to do now? All that he say’s “I wish I could do more”
      PLEASE don’t.

      Reply

      • Marsha Brady Says:

        Sounds like a preparation for “ObamaCare”. Start forcing insurance companies to jack up their low cost plans so that it pushes people into the socialized healthcare plans (Which are horrible & expensive). Let me guess, this Commissioner Kreidler is a Progressive leftist?

  2. Evan Says:

    First, thanks to the writer listed as “airfoil” for describing what the costs will be to his family because of the health care insurance change.

    I am interested to find out the degree that people are being financially effected by the loss of generic-only prescription drug coverage. Personally, with the loss of this coverage, I will need to spend an additional $180 per month. My copay was $48.00. I do not have the income to afford the medication and the new “WiseEssentials 6″ insurance policy. So, I will need to discontinue the Lifewise insurance coverage to be able to afford the medication. This will lead to additional dangers of being without health insurance coverage.

    I understand that over 40,000 customers have been effected by this new health plan law. I believe the cost to all the people needs to be found out. I called Lifewise but no information can not be released by them. Please post the financial effect this is having on you. Please ask other people to post their results as well.

    Secondly, I would like to find out what financial information the insurance commissioner used to determin the need to disallow generic-only prescription coverage. If anyone knows please post it.

    Note: As you may know the insurance commissioner, Mike Kreidler, is elected by the people of Washington State and his department is tax funded by over fifty-one million dollars per year. We should receive the BEST in insurance regulation.

    Reply

    • LifeWise Health Plan of Washington Says:

      Evan, thanks for your comment. We appreciate that drug costs can be expensive and that this change could lead to higher out-of-pocket costs for people who regularly use prescription drugs. LifeWise members who don’t have drug coverage (such as those on WiseEssentials 6) can still benefit from our discount drug program. We have negotiated savings on both brand name and generic drugs of up to 50% for our members. To see if your drugs are covered, and what the costs would be, you can contact our customer service team using the number on the back of your ID card, or use our online tool.

      We don’t have information on our members’ finances that would allow us to estimate the impact this will have on the 45,000 members of the WiseEssentials Rx Plan. What we can tell you is that this was our most popular plan and clearly a lot of people purchased this coverage because they valued the combination of a low monthly rate and generic-only drug coverage. WiseEssentials Rx was the only high-deductible plan in the state that offered any drug coverage at all and it’s unfortunate that this option will no longer be available to consumers in Washington.

      Reply

    • OurFamily Says:

      I am innocent there, I vote responsibly. Don’t know about others ….I’m just say’n.

      Reply

  3. Evan Says:

    Thanks for your comment LifeWise writer. I have investigated the “discount drug program” and it does report to pay UP TO 50%. However, for my medications, it provides less than 4% savings. Also, there are other “discount drug programs” that enable similar savings, but are not tied to a health insurance policy. These discount drug programs are not as good as the LifeWise insurance was in providing health care medications.

    Reply

  4. Evan Says:

    Have again been researching the internet for health insurance in Washington State. Found that some companies are still not available in my area. However there is a insurance organization called Community Health Plan of Washington. It has a policy called “Washington Health Program”. It is for individuals who Can pay for insurance. It Does cover generic medications. Their internet site is http://www.chpw.org. The premiums are similar to LifeWise. It is worth checking into.

    Reply

    • airfoil Says:

      Hi Evan. The issue here is that Lifewise – along with all insurers in Washington – is no longer able to offer a generic-only plan. Lifewise was unique in that they offered an affordable prescription plan for people and families who were content with having their prescription drug plan only cover generics. Lifewise still covers generic drugs, but due to Insurance Commissioner Mike Kreidler\’s harmful regulatory decision, no insurer in the state (including Lifewise) may offer a plan that does not also include coverage for brand name drugs. The result of this wrongheaded ruling is that nearly 50,000 people are now faced with either having no drug coverage at all, or having to pay much higher monthly premiums.

      I would encourage anyone affected by this to contact the Insurance Commissioner at http://www.insurance.wa.gov/about/ask_mike.shtml, and also remember that Mr. Kreidler is an elected official who can be replaced in November…

      Reply

    • marti Says:

      I know this is pretty sad, but after reading the previous comments, my fears about government and the insurance industry is confirmed. All I can think after this is that they are both in cahoots with each other to see just how much they can make off of the American people. I don’t think any official is voted in by the majority vote any more. There are some serious flaws in our system that need to be worked out and this is one of them. Even though I know that it may be Kreidler making these decisions, you almost have to see that this is financially benefiting not only the insurance companies, but also the big drug companies that seem to make such great profits with all sorts of government subsidized programs that comes out of our tax dollars. I too have been affected by this with lifewise. I have been on a prescription for many years and now will have to start either paying through the nose for it, or change to something that I can afford but may not work the same. It just isn’t right. It seems every time you turn around, you are being bent over. All the while, the illegal aliens get free healthcare, have a bunch of children who are legal… blah blah blah. I shouldn’t have started.

      Reply

      • OurFamily Says:

        I am so glad you said this and not me, I would have gotten in trouble, it’s all I can do to hold onto some kind of composure, I can’t believe .what this country is coming to. You nailedl it! Good for you for speaking you mind. You can do that in America, I think.

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